Provider Demographics
NPI:1093770323
Name:SIMON, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:920 ALBANY SHAKER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110
Mailing Address - Country:US
Mailing Address - Phone:518-533-6502
Mailing Address - Fax:518-533-6505
Practice Address - Street 1:920 ALBANY SHAKER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-533-6502
Practice Address - Fax:518-533-6505
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2023-04-10
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Provider Licenses
StateLicense IDTaxonomies
NY134338207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY206233OtherWELLCARE
NY000406953005OtherBLUE SHIELD
NY0499000OtherGHI
VT1001534Medicaid
NY17149OtherMVP
NY180045196OtherRAILROAD MEDICARE
NY409A91OtherBLUE CROSS
NY58812OtherGHI HMO
NY00652988Medicaid
NY10006172OtherCDPHP