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General NPI Number Information
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NPI Number | 1073538971
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Entity Type | Individual
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Provider Name | JEREMY IAN SIMON MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 825 OLD LANCASTER RD STE 100
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City | BRYN MAWR
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State | PA
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Zip | 19010-3234
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Country | US
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Telephone | 800-321-9999
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Fax | 267-479-1321
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Provider Business Mailing Address
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Address Line | 833 CHESTNUT ST STE 520
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4430
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Country | US
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Telephone | 800-321-9999
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD427039
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 290802
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | D65463
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MA09061400
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License Number State | NJ
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