Provider Demographics
NPI:1073619318
Name:ANDREW L. SIMON M.D., F.A.C.S, P.A.
Entity Type:Organization
Organization Name:ANDREW L. SIMON M.D., F.A.C.S, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-840-0900
Mailing Address - Street 1:459 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7724
Mailing Address - Country:US
Mailing Address - Phone:732-840-0900
Mailing Address - Fax:732-840-0912
Practice Address - Street 1:459 JACK MARTIN BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7724
Practice Address - Country:US
Practice Address - Phone:732-840-0900
Practice Address - Fax:732-840-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05112300208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ107864Medicare PIN