Provider Demographics
NPI:1437583291
Name:S. LAWRENCE SIMON, D.D.S., P.C.
Entity Type:Organization
Organization Name:S. LAWRENCE SIMON, D.D.S., P.C.
Other - Org Name:S. LAWRENCE SIMON, D.D.S., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:S. LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PC
Authorized Official - Phone:212-317-2055
Mailing Address - Street 1:30 CENTRAL PARK S
Mailing Address - Street 2:SUITE 10-D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1628
Mailing Address - Country:US
Mailing Address - Phone:212-317-2055
Mailing Address - Fax:212-317-2056
Practice Address - Street 1:30 CENTRAL PARK S
Practice Address - Street 2:SUITE 10-D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1628
Practice Address - Country:US
Practice Address - Phone:212-317-2055
Practice Address - Fax:212-317-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0246621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAS3135298OtherPRACTITIONER DEA NUMBER