Healthcare Provider Details

I. General information

NPI: 1346358744
Provider Name (Legal Business Name): PHILIP SIMKOVITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 PARK AVENUE SUITE 202
TRUMBULL CT
06611
US

IV. Provider business mailing address

5520 PARK AVE STE WP1-900
TRUMBULL CT
06611-3463
US

V. Phone/Fax

Practice location:
  • Phone: 203-365-0577
  • Fax: 203-365-0324
Mailing address:
  • Phone: 203-365-0577
  • Fax: 203-365-0324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number025732
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number025732
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: