Healthcare Provider Details

I. General information

NPI: 1487558904
Provider Name (Legal Business Name): JENA SIMON NP IN PSYCHIATRY AND FAMILY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 LINCOLN AVE
ARDSLEY NY
10502-2416
US

IV. Provider business mailing address

56 LINCOLN AVE
ARDSLEY NY
10502-2416
US

V. Phone/Fax

Practice location:
  • Phone: 917-268-1529
  • Fax: 917-268-9665
Mailing address:
  • Phone: 917-268-1529
  • Fax: 917-268-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENA SIMON
Title or Position: OWNER
Credential: DNP
Phone: 917-912-2946