Provider Demographics
NPI:1467796094
Name:SIMON SAADA, M.D., P.C.
Entity Type:Organization
Organization Name:SIMON SAADA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-238-1075
Mailing Address - Street 1:705 86 STREET
Mailing Address - Street 2:SIMON SAADA, M.D., P.C.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3220
Mailing Address - Country:US
Mailing Address - Phone:718-238-1075
Mailing Address - Fax:718-238-1174
Practice Address - Street 1:705 86 STREET
Practice Address - Street 2:SIMON SAADA, M.D., P.C.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3220
Practice Address - Country:US
Practice Address - Phone:718-238-1075
Practice Address - Fax:718-238-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129761208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00409352Medicaid
NYA100080283OtherPTAN
NYA100080283OtherPTAN