Provider Demographics
NPI:1811982424
Name:SIMON, CLAUDE D (MD PHD)
Entity type:Individual
Prefix:MR
First Name:CLAUDE
Middle Name:D
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:UPPER NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1215
Mailing Address - Country:US
Mailing Address - Phone:631-979-4400
Mailing Address - Fax:631-979-4475
Practice Address - Street 1:123 LAFAYETTE ST 5TH FL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3100
Practice Address - Country:US
Practice Address - Phone:917-881-9182
Practice Address - Fax:212-504-8041
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183220207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010183220NYOtherANTHEM HEALTH
NY01246967002OtherFIRST HEALTH
NY01217078Medicaid
NY2469671OtherOXFORD
NY2100618OtherGHI
NY183220OtherHIP
NY90F241Medicare ID - Type Unspecified