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General NPI Number Information
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NPI Number | 1437583291
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Entity Type | Organization
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Legal Business Name | S. LAWRENCE SIMON, D.D.S., P.C.
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 30 CENTRAL PARK S SUITE 10-D
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City | NEW YORK
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State | NY
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Zip | 10019-1628
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Country | US
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Telephone | 212-317-2055
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Fax | 212-317-2056
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Provider Business Mailing Address
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Address Line | 30 CENTRAL PARK S SUITE 10-D
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City | NEW YORK
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State | NY
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Zip | 10019-1628
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Country | US
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Telephone | 212-317-2055
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Fax | 212-317-2056
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. S. LAWRENCE SIMON
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Credential | D.D.S.,P.C.
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Telephone | 212-317-2055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 024662
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License Number State | NY
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