Healthcare Provider Details

I. General information

NPI: 1679690218
Provider Name (Legal Business Name): ORANGETOWN ORTHOPEDIC ASSOCIATES,LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 DUTCH HILL RD
ORANGEBURG NY
10962-2106
US

IV. Provider business mailing address

99 DUTCH HILL RD
ORANGEBURG NY
10962-2106
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-1877
  • Fax: 845-359-2449
Mailing address:
  • Phone: 845-359-1877
  • Fax: 845-359-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1671681
License Number StateNY

VIII. Authorized Official

Name: DR. JORDAN A. SIMON
Title or Position: PARTNER
Credential: MD
Phone: 845-359-1877