Provider Demographics
NPI:1962459123
Name:LEV SIMKHAYEV MD PC
Entity Type:Organization
Organization Name:LEV SIMKHAYEV MD PC
Other - Org Name:LEV SIMKHAYEV MD PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEV
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMKHAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-360-9996
Mailing Address - Street 1:3 BRUNSWICK WOODS DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5601
Mailing Address - Country:US
Mailing Address - Phone:732-360-9996
Mailing Address - Fax:
Practice Address - Street 1:3 BRUNSWICK WOODS DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:732-360-9996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07436200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9015001Medicaid