Healthcare Provider Details

I. General information

NPI: 1386309524
Provider Name (Legal Business Name): ERIK J SIMMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5623 N 11TH ST
PHILADELPHIA PA
19141-3607
US

IV. Provider business mailing address

5623 N 11TH ST
PHILADELPHIA PA
19141-3607
US

V. Phone/Fax

Practice location:
  • Phone: 267-303-3058
  • Fax:
Mailing address:
  • Phone: 267-303-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: