Provider Demographics
NPI:1245706704
Name:SIMON, TIARA (PA-C)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:100 WOODRUFF AVE APT 5F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1217
Mailing Address - Country:US
Mailing Address - Phone:347-645-9147
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVE -DEPT. OF SURGERY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:347-645-9147
Practice Address - Fax:718-270-2826
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty