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General NPI Number Information
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NPI Number | 1790998680
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Entity Type | Individual
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Provider Name | MAGDA A DE SIMONE R.P.A.-C.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 28 RYKOWSKI LN DERMATOLOGY CENTER AT CRYSTAL RUN
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City | MIDDLETOWN
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State | NY
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Zip | 10941-4018
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Country | US
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Telephone | 845-692-3376
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 223
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City | SUGAR LOAF
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State | NY
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Zip | 10981-0223
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Country | US
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Telephone | 917-301-8580
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 006407-1
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License Number State | NY
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