Healthcare Provider Details

I. General information

NPI: 1578648770
Provider Name (Legal Business Name): SIMON Z DJEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ESSEX ST
NEW YORK NY
10002-2301
US

IV. Provider business mailing address

60 MADISON AVE FLOOR 6 COMMUNITY HEALTHCARE NETWORK INC
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-1120
  • Fax: 212-477-8957
Mailing address:
  • Phone: 212-545-2439
  • Fax: 646-312-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number224469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: