=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851977193
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVA ANTOINETTE SIMISTER-IRVING LCSW PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2021
-----------------------------------------------------
Last Update Date | 03/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 730 E 232ND ST APT 3A
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10466-4115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-316-1914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 351
-----------------------------------------------------
City | POUGHQUAG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12570-0351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-316-1914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NOVA ANTOINETTE SIMISTER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 914-316-1914
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------