Healthcare Provider Details

I. General information

NPI: 1952306763
Provider Name (Legal Business Name): EUGENE JOSEPH SIMONI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BENNER PIKE STE 1
STATE COLLEGE PA
16801-7304
US

IV. Provider business mailing address

PO BOX 858 MC A410
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 814-272-5660
  • Fax: 814-272-5675
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD035825E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001054795
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier411011NZV
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE PTAN
# 3
Identifier2473818
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: