Provider Demographics
NPI:1295716462
Name:SIMONOFSKY, BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:SIMONOFSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 NEW HACKENSACK RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-4351
Mailing Address - Country:US
Mailing Address - Phone:845-462-2626
Mailing Address - Fax:845-462-6588
Practice Address - Street 1:1984 NEW HACKENSACK RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-4351
Practice Address - Country:US
Practice Address - Phone:845-462-2626
Practice Address - Fax:845-462-6588
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY937501OtherMVP
NYBCBSOtherX14881
NYCO21537OtherWORKERS COMPENSATION
NY39886617OtherTRIAD
NYP761893OtherOXFORD
NY128725OtherACN
NY0579021OtherONVOY
NY0579021OtherUS HEALTHCARE
NYCO21537OtherWORKERS COMPENSATION
NYT52141Medicare UPIN