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General NPI Number Information
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NPI Number | 1033236229
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Entity Type | Individual
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Provider Name | SIMON BIDERMAN PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 4012 80TH ST
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City | ELMHURST
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State | NY
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Zip | 11373-1234
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Country | US
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Telephone | 718-426-9595
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Fax | 718-426-2729
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Provider Business Mailing Address
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Address Line | 52 CLARK ST APT 3G
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City | BROOKLYN
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State | NY
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Zip | 11201-2417
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Country | US
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Telephone | 347-369-1312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 013040-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 013040
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License Number State | NY
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