Provider Demographics
NPI:1649429739
Name:SEGAL, SHIRI NICOLE (MD)
Entity type:Individual
Prefix:
First Name:SHIRI
Middle Name:NICOLE
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 BERGEN STREET
Mailing Address - Street 2:BUILDING 12 ROOM 1205
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3000
Mailing Address - Country:US
Mailing Address - Phone:973-972-0037
Mailing Address - Fax:973-972-0743
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-967-4000
Practice Address - Fax:201-967-4117
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2018-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY249571207R00000X
NJ25MA10294900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine