1497789358 NPI number — LAURIE ROBYN SIMON RD

Table of content: LAURIE ROBYN SIMON RD (NPI 1497789358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497789358 NPI number — LAURIE ROBYN SIMON RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
LAURIE
Provider Middle Name:
ROBYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD
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:
1497789358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 W 57TH ST
Provider Second Line Business Mailing Address:
STE 1414
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10019-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-896-1444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 W 57TH ST
Provider Second Line Business Practice Location Address:
STE. 1414
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-333-4243
Provider Business Practice Location Address Fax Number:
212-333-3468
Provider Enumeration Date:
07/10/2006

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: 133V00000X , with the licence number:  005974 , 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: 7215706 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8000304 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9487E1 . This is a "BLUECROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132845837 . This is a "MUTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3931564 . This is a "USHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132845837 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132845837 . This is a "BEECHSTREET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132845837 . This is a "HORIZON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2541855 . This is a "UNITED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8309174002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 005974 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: SL5974 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3604026 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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