Provider Demographics
NPI:1356359558
Name:SIMMONS, SABRINA (MD)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WYCKOFF PL
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1816
Mailing Address - Country:US
Mailing Address - Phone:732-940-3276
Mailing Address - Fax:
Practice Address - Street 1:28 WYCKOFF PL
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1816
Practice Address - Country:US
Practice Address - Phone:732-512-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05238000207V00000X
NHLT-2730207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1306891791Medicare ID - Type UnspecifiedFACILITY ID