Healthcare Provider Details

I. General information

NPI: 1669632287
Provider Name (Legal Business Name): BERNARD H SIMELTON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S BROADWAY
YONKERS NY
10701
US

IV. Provider business mailing address

1 ALEXANDER ST #308C
YONKERS NY
10701-7556
US

V. Phone/Fax

Practice location:
  • Phone: 914-378-7510
  • Fax:
Mailing address:
  • Phone: 860-335-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number263046-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number76201
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101277412
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: