Provider Demographics
NPI:1790894723
Name:LAUER, SIMEON A (MD)
Entity Type:Individual
Prefix:
First Name:SIMEON
Middle Name:A
Last Name:LAUER
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 1:130 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6136
Mailing Address - Country:US
Mailing Address - Phone:212-879-6824
Mailing Address - Fax:212-734-2682
Practice Address - Street 1:978 ROUTE 45
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-362-7706
Practice Address - Fax:212-734-2682
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164930207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01185868Medicaid
NYE07306Medicare UPIN
NY01185868Medicaid