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General NPI Number Information
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NPI Number | 1942563408
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Entity Type | Individual
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Provider Name | SIMON EDWARD MATES MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 1 GUSTAVE L LEVY PL # 1264
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City | NEW YORK
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State | NY
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Zip | 10029-6504
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Country | US
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Telephone | 212-241-8867
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GUSTAVE L LEVY PL BOX 1264
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City | NEW YORK
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State | NY
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Zip | 10029-6504
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Country | US
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Telephone | 212-241-8867
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 155147
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | D0079701
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License Number State | MD
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