Provider Demographics
NPI:1205854262
Name:SIMOTAS, ALEXANDER C (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:C
Last Name:SIMOTAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 E 75TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3102
Mailing Address - Country:US
Mailing Address - Phone:212-606-1879
Mailing Address - Fax:212-794-1921
Practice Address - Street 1:429 EAST 75TH STREET, 4TH FLOOR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4099
Practice Address - Country:US
Practice Address - Phone:212-606-1879
Practice Address - Fax:212-794-1921
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF50691Medicare UPIN
NY79K691Medicare ID - Type Unspecified