Healthcare Provider Details

I. General information

NPI: 1467942003
Provider Name (Legal Business Name): TREVOR SIMCOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SMITH HAVEN MALL STE 103
LAKE GROVE NY
11755-1251
US

IV. Provider business mailing address

STONY BROOK ORTHOPEDICS ASSOCIATES H.S.C T18 020
STONY BROOK NY
11794-8181
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4233
  • Fax:
Mailing address:
  • Phone: 631-444-7670
  • Fax: 631-444-7671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number312992
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: