Healthcare Provider Details

I. General information

NPI: 1265680532
Provider Name (Legal Business Name): CRESTVIEW QUALITY MEDICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CRESTVIEW TER
MONSEY NY
10952-1901
US

IV. Provider business mailing address

2 CRESTVIEW TER
MONSEY NY
10952-1901
US

V. Phone/Fax

Practice location:
  • Phone: 845-425-8300
  • Fax:
Mailing address:
  • Phone: 845-425-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID B SIMONS
Title or Position: OWNER
Credential:
Phone: 845-425-8300