Provider Demographics
NPI:1063666311
Name:SIMON OLSTEIN, M.D., P.C.
Entity Type:Organization
Organization Name:SIMON OLSTEIN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-843-3932
Mailing Address - Street 1:15223 N. 12TH ST.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3801
Mailing Address - Country:US
Mailing Address - Phone:602-843-3932
Mailing Address - Fax:602-843-3980
Practice Address - Street 1:6991 E. CAMELRACK RD.
Practice Address - Street 2:SUITE B-360 SCOTTSDALE TREATMENT INSTITUTE
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-429-9044
Practice Address - Fax:480-429-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8589208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty