Provider Demographics
NPI:1568491298
Name:SIMANTOV, JESSIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:SIMANTOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 BARNARD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2729
Mailing Address - Country:US
Mailing Address - Phone:516-374-9444
Mailing Address - Fax:212-730-8861
Practice Address - Street 1:640 BARNARD AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2729
Practice Address - Country:US
Practice Address - Phone:516-374-9444
Practice Address - Fax:212-730-8861
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229405208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation