1811982424 NPI number — MR. CLAUDE D SIMON MD PHD

Table of content: MR. CLAUDE D SIMON MD PHD (NPI 1811982424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811982424 NPI number — MR. CLAUDE D SIMON MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
CLAUDE
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811982424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 N BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER NYACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10960-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-979-4400
Provider Business Mailing Address Fax Number:
631-979-4475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 LAFAYETTE ST 5TH FL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10013-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-881-9182
Provider Business Practice Location Address Fax Number:
212-504-8041
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  183220 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010183220NY . This is a "ANTHEM HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01246967002 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01217078 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2469671 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2100618 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 183220 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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