Provider Demographics
NPI:1710928304
Name:SIMONS, STEPHAN B (MD)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:B
Last Name:SIMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-4900
Mailing Address - Country:US
Mailing Address - Phone:718-828-6610
Mailing Address - Fax:718-829-9132
Practice Address - Street 1:1211 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4900
Practice Address - Country:US
Practice Address - Phone:718-828-6610
Practice Address - Fax:718-829-9132
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01423972Medicaid
NYC08011Medicare UPIN
NY01423972Medicaid