1780633776 NPI number — JAIME J SIMON DO

Table of content: JAIME J SIMON DO (NPI 1780633776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780633776 NPI number — JAIME J SIMON DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
JAIME
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1780633776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 OLD COURT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANDALLSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21133-5103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-521-5680
Provider Business Mailing Address Fax Number:
410-521-7669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 HURFFVILLE CROSS KEYS ROAD
Provider Second Line Business Practice Location Address:
NEUROSCIENCE INTENSIVE CARE UNIT
Provider Business Practice Location Address City Name:
TURNERSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-582-3100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2006

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: 207RC0200X , with the licence number:  OS012090 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: H76747 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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