Provider Demographics
NPI:1790998680
Name:DE SIMONE, MAGDA A (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:MAGDA
Middle Name:A
Last Name:DE SIMONE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:SUGAR LOAF
Mailing Address - State:NY
Mailing Address - Zip Code:10981-0223
Mailing Address - Country:US
Mailing Address - Phone:917-301-8580
Mailing Address - Fax:
Practice Address - Street 1:28 RYKOWSKI LN
Practice Address - Street 2:DERMATOLOGY CENTER AT CRYSTAL RUN
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4018
Practice Address - Country:US
Practice Address - Phone:845-692-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006407-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant