Healthcare Provider Details

I. General information

NPI: 1043082407
Provider Name (Legal Business Name): EMILY SIMON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 CLOVE RD
STATEN ISLAND NY
10301-4314
US

IV. Provider business mailing address

115 VINELAND AVE
STATEN ISLAND NY
10312-2319
US

V. Phone/Fax

Practice location:
  • Phone: 718-494-2690
  • Fax:
Mailing address:
  • Phone: 917-930-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: