Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MA07890900 | NJ |
NPI | 1013938661 |
---|---|
Provider Name | Elana Tova Segal |
First Address | Sewell, NJ 08080-2237 |
Second Address | Sewell, NJ 08080-2237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 12/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I32988 | (02) |