Healthcare Provider Details

I. General information

NPI: 1851652614
Provider Name (Legal Business Name): SIMONE LOMAX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 TILLOTSON AVE
BRONX NY
10475-1560
US

IV. Provider business mailing address

11936 190TH ST
JAMAICA NY
11412-3621
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-2100
  • Fax:
Mailing address:
  • Phone: 347-731-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number654335
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: