Provider Demographics
NPI:1497789358
Name:SIMON, LAURIE ROBYN (RD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ROBYN
Last Name:SIMON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 57TH ST
Mailing Address - Street 2:STE 1414
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2401
Mailing Address - Country:US
Mailing Address - Phone:718-896-1444
Mailing Address - Fax:
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:STE. 1414
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-333-4243
Practice Address - Fax:212-333-3468
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005974133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7215706OtherAETNA
NY8000304OtherGHI
NY9487E1OtherBLUECROSS
NY132845837OtherMUTIPLAN
NY3931564OtherUSHC
NY132845837OtherPHCS
NY132845837OtherBEECHSTREET
NY132845837OtherHORIZON
NY2541855OtherUNITED
NY8309174002OtherCIGNA
NY005974OtherHIP
NYSL5974OtherATLANTIS
NYP3604026OtherOXFORD