Provider Demographics
NPI:1164706230
Name:SIMMONS, RICARDO D
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:D
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ALBEMARLE RD
Mailing Address - Street 2:APT A5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-8049
Mailing Address - Country:US
Mailing Address - Phone:718-769-8400
Mailing Address - Fax:718-769-3255
Practice Address - Street 1:2753 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5015
Practice Address - Country:US
Practice Address - Phone:718-769-8400
Practice Address - Fax:718-769-3255
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025441225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist