Provider Demographics
NPI:1093145401
Name:WILLIAM H. SIMON, M.D.
Entity Type:Organization
Organization Name:WILLIAM H. SIMON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAIMONDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-766-6808
Mailing Address - Street 1:2940 LINCOLN AVE
Mailing Address - Street 2:SUITE201
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2195
Mailing Address - Country:US
Mailing Address - Phone:516-766-6808
Mailing Address - Fax:516-766-5218
Practice Address - Street 1:2940 LINCOLN AVE
Practice Address - Street 2:SUITE201
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2195
Practice Address - Country:US
Practice Address - Phone:516-766-6808
Practice Address - Fax:516-766-5218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB79924Medicare UPIN