Provider Demographics
NPI:1942210703
Name:SIMON YOUNG DPM PC
Entity Type:Organization
Organization Name:SIMON YOUNG DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SEC'T -- TREAS/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-316-7000
Mailing Address - Street 1:31 HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3749
Mailing Address - Country:US
Mailing Address - Phone:845-215-5366
Mailing Address - Fax:
Practice Address - Street 1:110 W 96TH ST
Practice Address - Street 2:SUITE #1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6413
Practice Address - Country:US
Practice Address - Phone:212-316-7000
Practice Address - Fax:212-662-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY65 -- N003147213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIC0569OtherHEALTHNET/GUARDIAN
NY00582081Medicaid
NYNS3363OtherOXFORD
NY0011123OtherGHI
NY00582081Medicaid
NYIC0569OtherHEALTHNET/GUARDIAN