Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 061839 | NY |
N | 1223E0200X | Endodontist | 22DI02799400 | NJ |
N | 1223E0200X | Endodontist | DN24329 | FL |
NPI | 1144890542 |
---|---|
Provider Name | Dr. Randy Neil Simon |
First Address | New York, NY 10003-2663 |
Second Address | New York, NY 10003-2639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2021 |
Last Update Date | 24/08/2021 |