Healthcare Provider Details

I. General information

NPI: 1538022439
Provider Name (Legal Business Name): JASON ROSS SIMS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PLEASANT AVE
PLAINVIEW NY
11803-1411
US

IV. Provider business mailing address

7 PLEASANT AVE
PLAINVIEW NY
11803-1411
US

V. Phone/Fax

Practice location:
  • Phone: 516-564-7752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number821969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: