Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 163710 | NY |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 035038 | CT |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 163710 | NY |
NPI | 1851365449 |
---|---|
Provider Name | Robert M Simon |
First Address | Larchmont, NY 10538-1409 |
Second Address | Larchmont, NY 10538-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 04/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01644751/02338970 | (05) | NY |
133884168 | 1199 (01) | NY |
E34652 | (02) | NY |