MEDICARE: DR. STEVEN IRA SIMON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	136343	NY
2	207N00000X	Dermatology Physician	136343-11	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154329472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN IRA SIMON M.D.

Provider Business Mailing Address
First Line	:	2270 KIMBALL ST
Second Line	:	SUITE 201
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5139
Country	:	US
Telephone Number	:	718-253-4550
Fax Number	:	718-253-6430

Provider Business Practice Location Address
First Line	:	2270 KIMBALL ST
Second Line	:	SUITE 201
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5139
Country	:	US
Telephone Number	:	718-253-4550
Fax Number	:	718-253-6430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	02/10/2021

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