Provider Demographics
NPI:1902845464
Name:SIM, SANG E (MD)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:E
Last Name:SIM
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 1:1020A BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1509
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-923-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0739222085R0001X
NY2113172085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ187384OtherAMERIGROUP
NJ3245799OtherAETNA HMO
NJ1175590OtherHORIZON NJ HEALTH
NJP2717905OtherOXFORD
NJ0007295366OtherAETNA PPO
NJ01000597300OtherAMERICHOICE
NJ223522719OtherHORIZON BCBS
NJ223522719OtherUNITED HEALTHCARE
NJ2302E1OtherWELL CHOICE
NJ7007553OtherCIGNA
NJ8889503Medicaid
NJ2K7880OtherHEALTHNET
NJ0099584OtherGHI
NJ2226084000OtherAMERIHEALTH HMO
NJ223522719OtherUNITED HEALTHCARE
NJP00090217Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NJG34657Medicare UPIN