Healthcare Provider Details

I. General information

NPI: 1861311037
Provider Name (Legal Business Name): ALEXIS SIMON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 MERRICK RD STE 202
MERRICK NY
11566-4770
US

IV. Provider business mailing address

2209 MERRICK RD STE 202
MERRICK NY
11566-4770
US

V. Phone/Fax

Practice location:
  • Phone: 631-264-4521
  • Fax:
Mailing address:
  • Phone: 631-264-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS FORDYCE
Title or Position: NP
Credential:
Phone: 631-264-4521