1528235074 NPI number — SIMPSON ORAL & MAXILLOFACIAL SURGERY

Table of content: (NPI 1528235074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528235074 NPI number — SIMPSON ORAL & MAXILLOFACIAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
SIMPSON ORAL & MAXILLOFACIAL SURGERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1528235074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 NORTH MIDDLETOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANUET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-623-3497
Provider Business Mailing Address Fax Number:
845-623-4039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 NORTH MIDDLETOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANUET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-623-3497
Provider Business Practice Location Address Fax Number:
845-623-4039
Provider Enumeration Date:
05/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIMPSON
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-623-3497

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  42385 , 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: 01280620 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: RS279 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 747990 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: SD323 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".