Provider Demographics
NPI:1831900992
Name:SIMON, KEVIN (MBA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 FRELINGHUYSEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-1404
Mailing Address - Country:US
Mailing Address - Phone:973-596-2850
Mailing Address - Fax:973-596-8181
Practice Address - Street 1:461 FRELINGHUYSEN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-1404
Practice Address - Country:US
Practice Address - Phone:973-596-2850
Practice Address - Fax:973-596-8180
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator