Provider Demographics
NPI:1033236229
Name:BIDERMAN, SIMON (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:
Last Name:BIDERMAN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CLARK ST
Mailing Address - Street 2:APT 3G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2417
Mailing Address - Country:US
Mailing Address - Phone:347-369-1312
Mailing Address - Fax:
Practice Address - Street 1:4012 80TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1234
Practice Address - Country:US
Practice Address - Phone:718-426-9595
Practice Address - Fax:718-426-2729
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013040-1174400000X
NY013040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300000388Medicare PIN