Healthcare Provider Details

I. General information

NPI: 1285337014
Provider Name (Legal Business Name): SIMON J. INNABI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 N BROADWAY
YONKERS NY
10701-1301
US

IV. Provider business mailing address

51 ANNSVILLE TRL
YONKERS NY
10703-1603
US

V. Phone/Fax

Practice location:
  • Phone: 914-512-1733
  • Fax:
Mailing address:
  • Phone: 914-512-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1285337014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: