Provider Demographics
NPI:1700996311
Name:BEN-DAVID, SIMCHA B (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMCHA
Middle Name:B
Last Name:BEN-DAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 16 AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-435-6363
Mailing Address - Fax:718-438-8248
Practice Address - Street 1:5211 16 AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-435-6363
Practice Address - Fax:718-438-8248
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135036207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY135036OtherLICENSE
27A231Medicare ID - Type Unspecified
NY135036OtherLICENSE