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NPI Code Detail

MEDICARE: DR. JESSICA SIMON M.D

MEDICARE: DR. JESSICA SIMON 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
1174400000XSpecialist2MA09671000NJ
2207N00000XDermatology PhysicianTRN16566FL

General Provider Information

NPI Number : 1659651099
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA SIMON M.D
Provider Business Mailing Address
First Line : 59 ONE MILE ROAD EXT SUITE G
Second Line :
City : EAST WINDSOR
State : NJ
Zip : 08520
Country : US
Telephone Number : 609-443-4500
Fax Number :
Provider Business Practice Location Address
First Line : 59 ONE MILE RD EXT STE G
Second Line :
City : EAST WINDSOR
State : NJ
Zip : 08520-2505
Country : US
Telephone Number : 609-443-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2011
Last Update Date : 10/14/2015

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