Healthcare Provider Details

I. General information

NPI: 1548176035
Provider Name (Legal Business Name): JEFFREY H SIMON MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RABBIT RUN RD
MALVERN PA
19355-3436
US

IV. Provider business mailing address

8 RABBIT RUN RD
MALVERN PA
19355-3436
US

V. Phone/Fax

Practice location:
  • Phone: 610-220-6916
  • Fax:
Mailing address:
  • Phone: 610-220-6916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALPHONSO JOSIAH NATHAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 267-902-9319