Provider Demographics
NPI:1669707881
Name:SEGALL, BRYAN WHITMAN (SCLA, CSAA)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:WHITMAN
Last Name:SEGALL
Suffix:
Gender:M
Credentials:SCLA, CSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2735
Mailing Address - Country:US
Mailing Address - Phone:646-322-2970
Mailing Address - Fax:718-458-5335
Practice Address - Street 1:4902 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4444
Practice Address - Country:US
Practice Address - Phone:718-458-5333
Practice Address - Fax:718-458-5335
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor