Provider Demographics
NPI:1285853614
Name:SIMEON, JEAN BAPTISTE (MD)
Entity Type:Individual
Prefix:MR
First Name:JEAN BAPTISTE
Middle Name:
Last Name:SIMEON
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 1:175 EASTERN PKWY
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6006
Mailing Address - Country:US
Mailing Address - Phone:718-398-0093
Mailing Address - Fax:718-398-2997
Practice Address - Street 1:175 EASTERN PKWY
Practice Address - Street 2:SUITE 1D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6006
Practice Address - Country:US
Practice Address - Phone:718-398-0093
Practice Address - Fax:718-398-2997
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155139207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00946658Medicaid
NY73D371Medicare ID - Type Unspecified
59111Medicare UPIN