Provider Demographics
NPI:1912109687
Name:SIMONE FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:SIMONE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-290-8300
Mailing Address - Street 1:746 STATE ROUTE 34
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-6685
Mailing Address - Country:US
Mailing Address - Phone:732-290-8300
Mailing Address - Fax:732-290-8301
Practice Address - Street 1:746 STATE ROUTE 34
Practice Address - Street 2:SUITE 2
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-6685
Practice Address - Country:US
Practice Address - Phone:732-290-8300
Practice Address - Fax:732-290-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 70752261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H21438Medicare UPIN