Provider Demographics
NPI:1356652341
Name:SIMON, JENA MARIE (DNP)
Entity type:Individual
Prefix:DR
First Name:JENA
Middle Name:MARIE
Last Name:SIMON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:MARIE
Other - Last Name:SRIVASTAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:56 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2416
Mailing Address - Country:US
Mailing Address - Phone:917-912-2946
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE OFC 903-10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:347-707-7735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2331839363LF0000X, 363LP0808X
VA24189470363LF0000X, 363LP0808X
MDR265902363LF0000X, 363LP0808X
WAAP61508873363LF0000X, 363LP0808X
NY336355363LF0000X
NY404817363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily