Provider Demographics
NPI:1093008864
Name:SIMON, ELIZABETH B (ANP)
Entity Type:Individual
Prefix:PROF
First Name:ELIZABETH
Middle Name:B
Last Name:SIMON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LYNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3601
Mailing Address - Country:US
Mailing Address - Phone:914-723-4335
Mailing Address - Fax:914-723-4335
Practice Address - Street 1:11 LYNWOOD RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3601
Practice Address - Country:US
Practice Address - Phone:914-723-4335
Practice Address - Fax:914-723-4335
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305568363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health