1477700870 NPI number — MR. NICHOLAS GERARD SIMONE RPH.

Table of content: MR. NICHOLAS GERARD SIMONE RPH. (NPI 1477700870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477700870 NPI number — MR. NICHOLAS GERARD SIMONE RPH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMONE
Provider First Name:
NICHOLAS
Provider Middle Name:
GERARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH.
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:
1477700870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3104 BROADWAY
Provider Second Line Business Mailing Address:
BONUS DRUG AND SURGICAL
Provider Business Mailing Address City Name:
ASTORIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11106-2649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-274-9200
Provider Business Mailing Address Fax Number:
718-274-0070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3104 BROADWAY
Provider Second Line Business Practice Location Address:
BONUS DRUG AND SURGICAL
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11106-2649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-274-9200
Provider Business Practice Location Address Fax Number:
718-274-0070
Provider Enumeration Date:
08/27/2008

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: 183500000X , with the licence number:  038961 , 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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