Provider Demographics
NPI:1497721062
Name:SANTOS ARIAS, SIMON B (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:B
Last Name:SANTOS ARIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIMON
Other - Middle Name:BOLIVAR
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:410 36TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4712
Mailing Address - Country:US
Mailing Address - Phone:201-863-7744
Mailing Address - Fax:201-863-7608
Practice Address - Street 1:410 36TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4712
Practice Address - Country:US
Practice Address - Phone:201-863-7744
Practice Address - Fax:201-863-7608
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34521207Q00000X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0470406Medicaid
NJ442858Medicare PIN
D96653Medicare UPIN