Provider Demographics
NPI:1760708119
Name:SIMPSON, TUKK
Entity Type:Individual
Prefix:
First Name:TUKK
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12928-2668
Mailing Address - Country:US
Mailing Address - Phone:518-597-3343
Mailing Address - Fax:
Practice Address - Street 1:2668 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:NY
Practice Address - Zip Code:12928-2668
Practice Address - Country:US
Practice Address - Phone:518-597-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY975322728344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY091110000148OtherFIDELIS CARE NY