Provider Demographics
NPI:1548605371
Name:SIMON, TONYA P (LPN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:P
Last Name:SIMON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 OSBORN ST
Mailing Address - Street 2:2FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5232
Mailing Address - Country:US
Mailing Address - Phone:347-276-1830
Mailing Address - Fax:
Practice Address - Street 1:591 OSBORN ST
Practice Address - Street 2:2FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5232
Practice Address - Country:US
Practice Address - Phone:347-276-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314208164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse