Provider Demographics
NPI:1861747339
Name:SEGURA, CARMEN (MS)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:SEGURA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 PIERMONT AVE
Mailing Address - Street 2:APT. 3C
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4624
Mailing Address - Country:US
Mailing Address - Phone:914-980-4789
Mailing Address - Fax:
Practice Address - Street 1:294 PIERMONT AVE
Practice Address - Street 2:APT. 3C
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-4624
Practice Address - Country:US
Practice Address - Phone:914-980-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist