Provider Demographics
NPI:1417908468
Name:SIMON, PAUL J (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:SIMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-1247
Mailing Address - Country:US
Mailing Address - Phone:732-349-3838
Mailing Address - Fax:732-349-2233
Practice Address - Street 1:99 HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6423
Practice Address - Country:US
Practice Address - Phone:732-557-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB048321207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1130329OtherMHP
5126401OtherAMGP
220018740OtherRRM
NJ5126401Medicaid
0539253000OtherAMERIHEALTH
5126401OtherAMGP
NJ703677Medicare ID - Type Unspecified