Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | OS012101 | PA |
NPI | 1073516670 |
---|---|
Provider Name | Dr. Eileen P. Simak |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Allentown, PA 18102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 15/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100956367 | (05) | PA |
I07850 | (02) | PA |