Provider Demographics
NPI:1508943762
Name:DIAGNOSTIC BREAST CENTER
Entity Type:Organization
Organization Name:DIAGNOSTIC BREAST CENTER
Other - Org Name:BARRY SIMON, M,D, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-478-0101
Mailing Address - Street 1:2161 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6607
Mailing Address - Country:US
Mailing Address - Phone:561-478-0101
Mailing Address - Fax:561-478-2085
Practice Address - Street 1:2161 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6607
Practice Address - Country:US
Practice Address - Phone:561-478-0101
Practice Address - Fax:561-478-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93667AMedicare ID - Type Unspecified
FLD64601Medicare UPIN