MEDICARE: DR. RYAN W SIMOVITCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	ME94929	FL
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	94929	FL

General Provider Information

NPI Number	:	1124048236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN W SIMOVITCH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 22076
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-2076
Country	:	US
Telephone Number	:	561-657-4600
Fax Number	:	561-694-3099

Provider Business Practice Location Address
First Line	:	300 PALM BEACH LAKES BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-2711
Country	:	US
Telephone Number	:	561-657-4600
Fax Number	:	561-657-4605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	04/29/2021

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