1295361616 NPI number — MRS. NICOLE BEATRICE SIMONSON F.N.P.

Table of content: MRS. NICOLE BEATRICE SIMONSON F.N.P. (NPI 1295361616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295361616 NPI number — MRS. NICOLE BEATRICE SIMONSON F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMONSON
Provider First Name:
NICOLE
Provider Middle Name:
BEATRICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADY
Provider Other First Name:
NICOLE
Provider Other Middle Name:
BEATRICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
F.N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295361616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
686 ROUTE 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-262-8200
Provider Business Mailing Address Fax Number:
732-262-8203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
484 TEMPLE HILL ROAD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
NEW WINDSOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-262-8200
Provider Business Practice Location Address Fax Number:
732-262-8203
Provider Enumeration Date:
03/17/2020

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: 363LF0000X , with the licence number:  26NJ01012300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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