Provider Demographics
NPI:1750309563
Name:DAEFLER, SIMON M (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:M
Last Name:DAEFLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 3000
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-987-3100
Mailing Address - Fax:212-731-5210
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-6741
Practice Address - Fax:212-534-3240
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY234252207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2V4851Medicare ID - Type Unspecified
H31673Medicare UPIN