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General NPI Number Information
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NPI Number | 1144890542
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Entity Type | Individual
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Provider Name | RANDY NEIL SIMON DDS
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Gender | Male
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 400 E 56TH ST OFC 1
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City | NEW YORK
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State | NY
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Zip | 10022-4339
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Country | US
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Telephone | 212-257-3393
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Fax |
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Provider Business Mailing Address
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Address Line | 26 TREEVIEW DR
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City | MELVILLE
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State | NY
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Zip | 11747-2411
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Country | US
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Telephone | 516-457-4777
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 22DI02799400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN24329
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 061839
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License Number State | NY
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