Provider Demographics
NPI:1831484740
Name:PROTEASA, SIMONA VASILICA (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMONA
Middle Name:VASILICA
Last Name:PROTEASA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SIMONA
Other - Middle Name:VASILICA
Other - Last Name:HERES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:611 NORTHERN BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5207
Mailing Address - Country:US
Mailing Address - Phone:516-325-7000
Mailing Address - Fax:516-325-7001
Practice Address - Street 1:611 NORTHERN BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5207
Practice Address - Country:US
Practice Address - Phone:516-325-7000
Practice Address - Fax:516-325-7001
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2702522084N0400X
NY123472084N0402X
NY10632084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology