Healthcare Provider Details

I. General information

NPI: 1568805323
Provider Name (Legal Business Name): JESSICA GAYLE LEVY-SIMON DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 COMMERCE WAY SUITE 100
PORTSMOUTH NH
03801-3244
US

IV. Provider business mailing address

215 COMMERCE WAY SUITE 100
PORTSMOUTH NH
03801-3244
US

V. Phone/Fax

Practice location:
  • Phone: 603-433-0056
  • Fax: 603-433-0029
Mailing address:
  • Phone: 603-433-0056
  • Fax: 603-433-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number2184
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number011622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: