Provider Demographics
NPI:1770736530
Name:SEGAL, ERIC BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRIAN
Last Name:SEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:690 N BROADWAY
Mailing Address - Street 2:GL1
Mailing Address - City:N WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2417
Mailing Address - Country:US
Mailing Address - Phone:914-428-3651
Mailing Address - Fax:914-428-2948
Practice Address - Street 1:690 N BROADWAY
Practice Address - Street 2:GL1
Practice Address - City:N WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-2417
Practice Address - Country:US
Practice Address - Phone:914-428-3651
Practice Address - Fax:914-428-2948
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2017-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2503002080P0008X, 2084N0402X
NJ25MA089853002084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0286389Medicaid
NY03623925Medicaid
NJ238567M60Medicare PIN
NJ0286389Medicaid