=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720229883
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHELDON SIMON, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2009
-----------------------------------------------------
Last Update Date | 03/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 UNION SQ E STE 3M
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-844-6733
-----------------------------------------------------
Fax | 212-244-6757
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 UNION SQ E STE 3M
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-844-6733
-----------------------------------------------------
Fax | 212-244-6757
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHELDON SIMON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-844-6733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 212549
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------