=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063666311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMON OLSTEIN, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2008
-----------------------------------------------------
Last Update Date | 11/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6991 E. CAMELRACK RD. SUITE B-360 SCOTTSDALE TREATMENT INSTITUTE
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-429-9044
-----------------------------------------------------
Fax | 480-429-9048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15223 N. 12TH ST.
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-843-3932
-----------------------------------------------------
Fax | 602-843-3980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SIMON OLSTEIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 602-843-3932
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 8589
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------