Provider Demographics
NPI:1164666756
Name:VILAIRE, SIMONE AVRIL (DC)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:AVRIL
Last Name:VILAIRE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SAINT CHARLES PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4108
Mailing Address - Country:US
Mailing Address - Phone:917-456-2951
Mailing Address - Fax:
Practice Address - Street 1:690 BAY ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3830
Practice Address - Country:US
Practice Address - Phone:917-456-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00605100111N00000X
NYX010054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor