Basic Information
Provider Information
NPI: 1316928468
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEGAL
FirstName: BRAHM
MiddleName: HILLEL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: ELM AND CARLTON ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142630001
CountryCode: US
TelephoneNumber: 7168452300
FaxNumber: 7168455777
Practice Location
Address1: ELM AND CARLTON ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142630001
CountryCode: US
TelephoneNumber: 7168452300
FaxNumber: 7168455777
Other Information
ProviderEnumerationDate: 11/07/2005
LastUpdateDate: 02/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X213755-1NYY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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