MEDICARE: SIMION E DAVIS

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	164W00000X	Licensed Practical Nurse	239564-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	239564-1	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1184947426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMION E DAVIS

Provider Business Mailing Address
First Line	:	1023 COLLEGE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-5852
Country	:	US
Telephone Number	:	646-721-5321
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 COLLEGE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-5852
Country	:	US
Telephone Number	:	646-721-5321
Fax Number	:

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

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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Directions to “ SIMION E DAVIS ” Practice Location

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