Provider Demographics
NPI:1861460552
Name:SIMPSON, ROGER LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:LAWRENCE
Last Name:SIMPSON
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 1:999 FRANKLIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2913
Mailing Address - Country:US
Mailing Address - Phone:516-742-3404
Mailing Address - Fax:516-535-6755
Practice Address - Street 1:999 FRANKLIN AVENUE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2913
Practice Address - Country:US
Practice Address - Phone:516-535-6744
Practice Address - Fax:516-535-6755
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1291152086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C07199Medicare UPIN
NYC07199Medicare UPIN
25A381Medicare PIN