Provider Demographics
NPI:1013213479
Name:MARDAKH, SIMON (MD)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:
Last Name:MARDAKH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:2 CATHERINE ST PARK SLOPE ANESTHESIA ASSOCIATES, PC
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:845-790-2614
Mailing Address - Fax:845-790-2613
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:NY METHODIST HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-780-3279
Practice Address - Fax:845-790-2613
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2015-01-06
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Provider Licenses
StateLicense IDTaxonomies
NY269292207L00000X
NY269292-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology