MEDICARE: DR. MINEL RACHEL SIMO DMD

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	122300000X	Dentist	22DI02639500	NJ

General Provider Information

NPI Number	:	1205388360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINEL RACHEL SIMO DMD

Provider Business Mailing Address
First Line	:	2229 US HIGHWAY 1
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4402
Country	:	US
Telephone Number	:	732-940-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2229 US HIGHWAY 1
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4402
Country	:	US
Telephone Number	:	732-940-0222
Fax Number	:

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

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	01/09/2023

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