Provider Demographics
NPI:1427586510
Name:SIMAREN, ADEOLA
Entity Type:Individual
Prefix:MRS
First Name:ADEOLA
Middle Name:
Last Name:SIMAREN
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 1:80 WICKS PATH
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4634
Mailing Address - Country:US
Mailing Address - Phone:631-492-8081
Mailing Address - Fax:
Practice Address - Street 1:80 WICKS PATH
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4634
Practice Address - Country:US
Practice Address - Phone:631-492-8081
Practice Address - Fax:631-492-8081
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035067-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist