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General NPI Number Information
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NPI Number | 1245315142
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Entity Type | Individual
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Provider Name | JONATHAN M SIMON
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 305 E 55TH ST STE 106
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City | NEW YORK
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State | NY
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Zip | 10022-4148
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Country | US
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Telephone | 212-224-0087
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Fax |
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Provider Business Mailing Address
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Address Line | 116 PINEHURST AVE B 33
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City | NEW YORK
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State | NY
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Zip | 10033-1755
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Country | US
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Telephone |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 001754
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License Number State | NY
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