Provider Demographics
NPI:1013938661
Name:SEGAL, ELANA TOVA (MD)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:TOVA
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS WAY E STE A3
Mailing Address - Street 2:WASHINGTON PAVILIONS
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2237
Mailing Address - Country:US
Mailing Address - Phone:856-589-3331
Mailing Address - Fax:856-589-3416
Practice Address - Street 1:100 KINGS WAY E STE A3
Practice Address - Street 2:WASHINGTON PAVILIONS
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2237
Practice Address - Country:US
Practice Address - Phone:856-589-3331
Practice Address - Fax:856-589-3416
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07890900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
092203Medicare ID - Type Unspecified
I32988Medicare UPIN