Provider Demographics
NPI:1477723682
Name:ANDREW L SIMON M D - IMRT LLC
Entity Type:Organization
Organization Name:ANDREW L SIMON M D - IMRT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-840-0900
Mailing Address - Street 1:2517 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2134
Mailing Address - Country:US
Mailing Address - Phone:732-840-0900
Mailing Address - Fax:732-840-0912
Practice Address - Street 1:900 ROUTE 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5940
Practice Address - Country:US
Practice Address - Phone:732-840-0900
Practice Address - Fax:732-840-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA051123002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty