Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 216446 | MA |
NPI | 1104887678 |
---|---|
Provider Name | Dr. Jill Zimmer Simon |
First Address | Lexington, MA 02421 |
Second Address | Newton, MA 02462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2091046 | (05) | MA |
469103 | TUFTS (01) | |
AA39789 | HARVARD PILGRIM (01) | |
I12879 | (02) | |
J28383 | BLUE SHIELD (01) |