=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417106774
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EYAL SIMCHI DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2008
-----------------------------------------------------
Last Update Date | 11/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 RIVERFRONT BLVD STE 2
-----------------------------------------------------
City | ELMWOOD PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07407-1042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-880-8130
-----------------------------------------------------
Fax | 201-820-2480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 RIVERFRONT BLVD STE 2
-----------------------------------------------------
City | ELMWOOD PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07407-1042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 12-880-8130
-----------------------------------------------------
Fax | 201-820-2480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 22DI02380900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------