Healthcare Provider Details

I. General information

NPI: 1669530408
Provider Name (Legal Business Name): SIMELA MEDICAL ARTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 FULTON AVE
HEMPSTEAD NY
11550
US

IV. Provider business mailing address

680 FULTON AVENUE
HEMPSTEAD NY
11550
US

V. Phone/Fax

Practice location:
  • Phone: 516-486-2669
  • Fax: 516-486-5539
Mailing address:
  • Phone: 516-486-2669
  • Fax: 516-486-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number145725
License Number StateNY

VIII. Authorized Official

Name: ERNEST D SIMELA
Title or Position: OWNER
Credential: MD
Phone: 576-486-2669