Provider Demographics
NPI:1225591654
Name:SIMONE, LAURIE MARIA
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:MARIA
Last Name:SIMONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 RIVER DR FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1601
Mailing Address - Country:US
Mailing Address - Phone:973-573-2099
Mailing Address - Fax:
Practice Address - Street 1:125 PATERSON ST RM 2100
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-6630
Practice Address - Fax:732-235-5230
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS