Provider Demographics
NPI:1417206806
Name:SIMEONI, RICHARD DOMENIC (PT)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DOMENIC
Last Name:SIMEONI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:885 2ND AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2201
Mailing Address - Country:US
Mailing Address - Phone:212-759-2882
Mailing Address - Fax:212-759-2996
Practice Address - Street 1:885 2ND AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2201
Practice Address - Country:US
Practice Address - Phone:212-759-2882
Practice Address - Fax:212-759-2996
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035068-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic