Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 030264 | NY |
NPI | 1083971139 |
---|---|
Provider Name | Dr. Jeffrey Eric Simon |
First Address | Larchmont, NY 10538-2534 |
Second Address | Larchmont, NY 10538-2534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2012 |
Last Update Date | 13/04/2012 |