Provider Demographics
NPI:1427034974
Name:SIMON, HEROLD
Entity Type:Individual
Prefix:DR
First Name:HEROLD
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HEROLD
Other - Middle Name:
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:328 ARKANSAS DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1804
Mailing Address - Country:US
Mailing Address - Phone:516-561-3040
Mailing Address - Fax:718-240-0564
Practice Address - Street 1:176 FENIMORE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5311
Practice Address - Country:US
Practice Address - Phone:718-940-0400
Practice Address - Fax:718-940-8327
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175968207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01191588Medicaid
E45186Medicare UPIN
NY50F492Medicare PIN