Provider Demographics
NPI:1346346293
Name:SIMPSON, MITCHELL E (MS, PT)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:E
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3025
Mailing Address - Country:US
Mailing Address - Phone:201-833-0234
Mailing Address - Fax:
Practice Address - Street 1:316 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3025
Practice Address - Country:US
Practice Address - Phone:201-833-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01108500225100000X
NY017878-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094512VATMedicare ID - Type UnspecifiedMEDICARE #
NJ100325Medicare PIN