Provider Demographics
NPI:1962686188
Name:SIMEON CARVAJAL MD PC
Entity Type:Organization
Organization Name:SIMEON CARVAJAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-262-9176
Mailing Address - Street 1:613 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1503
Mailing Address - Country:US
Mailing Address - Phone:201-262-9176
Mailing Address - Fax:718-518-5111
Practice Address - Street 1:SIMEON CARVAJAL MD PC
Practice Address - Street 2:BRONX LABANON HOSP. 1650 GRAND CONCOURSE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-0001
Practice Address - Country:US
Practice Address - Phone:718-518-5550
Practice Address - Fax:718-518-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1157921207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty