Provider Demographics
NPI:1811921463
Name:SIMON, LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:
Last Name:SIMON
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:PO BOX 1341
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-0963
Mailing Address - Country:US
Mailing Address - Phone:631-765-4150
Mailing Address - Fax:631-765-4688
Practice Address - Street 1:44210 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-5032
Practice Address - Country:US
Practice Address - Phone:631-765-4150
Practice Address - Fax:631-765-4688
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153210207R00000X
NY153210-1207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00757786Medicaid
NYA400084350Medicare PIN
NYB87339Medicare UPIN