Healthcare Provider Details

I. General information

NPI: 1548069636
Provider Name (Legal Business Name): JOHN SIMON MSN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 RIVER RD
POINT PLEASANT BORO NJ
08742-2054
US

IV. Provider business mailing address

79 E RAILROAD AVE
JAMESBURG NJ
08831-1207
US

V. Phone/Fax

Practice location:
  • Phone: 856-818-4020
  • Fax:
Mailing address:
  • Phone: 732-561-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15285000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: