Provider Demographics
NPI:1376350751
Name:SIMONIAN, AHNIE (APN)
Entity type:Individual
Prefix:
First Name:AHNIE
Middle Name:
Last Name:SIMONIAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W SPRING VALLEY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1444
Mailing Address - Country:US
Mailing Address - Phone:201-291-4075
Mailing Address - Fax:201-881-0109
Practice Address - Street 1:255 W SPRING VALLEY AVE STE 202
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1444
Practice Address - Country:US
Practice Address - Phone:201-291-4075
Practice Address - Fax:201-881-0109
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15189000363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care