1447668041 NPI number — MS. ERICA STEPHANIE SIMONE ATC, OTC

Table of content: MS. ERICA STEPHANIE SIMONE ATC, OTC (NPI 1447668041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447668041 NPI number — MS. ERICA STEPHANIE SIMONE ATC, OTC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMONE
Provider First Name:
ERICA
Provider Middle Name:
STEPHANIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ATC, OTC
Provider Gender Code:
F

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:
1447668041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 SOUTHFIELD AVE
Provider Second Line Business Mailing Address:
1408
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06902-7756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-291-1980
Provider Business Practice Location Address Fax Number:
973-694-2692
Provider Enumeration Date:
07/27/2014

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: 2255A2300X , with the licence number:  820 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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