Provider Demographics
NPI:1710045281
Name:SIMON, LAWRENCE F (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:F
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CROSFIELD AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2222
Mailing Address - Country:US
Mailing Address - Phone:845-535-3362
Mailing Address - Fax:845-535-3368
Practice Address - Street 1:1CROSFIELD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994
Practice Address - Country:US
Practice Address - Phone:845-535-3362
Practice Address - Fax:845-535-3368
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY096815-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00496373Medicaid
NY00496373Medicaid
NY62625Medicare ID - Type UnspecifiedMEDICARE