Provider Demographics
NPI:1952406076
Name:WOLFE-SIMON MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:WOLFE-SIMON MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-667-1654
Mailing Address - Street 1:511 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1503
Mailing Address - Country:US
Mailing Address - Phone:856-667-1654
Mailing Address - Fax:856-482-8057
Practice Address - Street 1:511 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1503
Practice Address - Country:US
Practice Address - Phone:856-667-1654
Practice Address - Fax:856-482-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2219154457OtherGEHA
PA=========OtherINDEPENDENCE BCBS
=========OtherHORIZON BCBSNJ
=========OtherTRICARE
2219154457OtherGEHA
=========OtherAETNA
=========OtherUNITED HEALTH CARE
=========OtherGREAT WEST
=========OtherAMERIHEALTH
=========OtherHEALTHNET
NJ=========Medicaid
=========OtherCIGNA
NJ=========OtherAMERICHOICE
=========OtherGHI
=========OtherUS DEPT OF LABOR
=========OtherINTERGROUP
NJ=========OtherAMERICHOICE