1417206806 NPI number — DR. RICHARD DOMENIC SIMEONI PT

Table of content: DR. RICHARD DOMENIC SIMEONI PT (NPI 1417206806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417206806 NPI number — DR. RICHARD DOMENIC SIMEONI PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMEONI
Provider First Name:
RICHARD
Provider Middle Name:
DOMENIC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1417206806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
885 2ND AVE
Provider Second Line Business Mailing Address:
LOWER LEVEL
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10017-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-759-2882
Provider Business Mailing Address Fax Number:
212-759-2996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
885 2ND AVE
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10017-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-759-2882
Provider Business Practice Location Address Fax Number:
212-759-2996
Provider Enumeration Date:
08/31/2012

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: 2251X0800X , with the licence number:  035068-1 , 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)





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