Provider Demographics
NPI:1629039474
Name:SIMON, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SIMON
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 1:216 E 99TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6808
Mailing Address - Country:US
Mailing Address - Phone:646-536-5500
Mailing Address - Fax:646-536-5514
Practice Address - Street 1:216 E 99TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6808
Practice Address - Country:US
Practice Address - Phone:646-536-5500
Practice Address - Fax:646-536-5514
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02236304Medicaid
NY02236304Medicaid
50C831Medicare ID - Type Unspecified