Provider Demographics
NPI:1093046864
Name:SIMON, JAE E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JAE
Middle Name:E
Last Name:SIMON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2984 STATE ROUTE 244
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:14813-9778
Mailing Address - Country:US
Mailing Address - Phone:585-268-7306
Mailing Address - Fax:
Practice Address - Street 1:2984 ROUTE 244
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813-9778
Practice Address - Country:US
Practice Address - Phone:585-268-7306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2489581164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse