Provider Demographics
NPI:1144469933
Name:SIMONE, GREGORY ROBERT (PT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ROBERT
Last Name:SIMONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2418
Mailing Address - Country:US
Mailing Address - Phone:516-582-1554
Mailing Address - Fax:
Practice Address - Street 1:256 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2418
Practice Address - Country:US
Practice Address - Phone:516-582-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist