MEDICARE: MS. PAMELA D SIMON

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	251C00000X	Developmentally Disabled Services Day Training Agency	870734	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	UNKNOWN	OTHER		UNKNOWN

General Provider Information

NPI Number	:	1306575865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA D SIMON

Provider Business Mailing Address
First Line	:	1234 E 83RD ST # 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4933
Country	:	US
Telephone Number	:	718-209-5465
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 E 83RD ST # 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4933
Country	:	US
Telephone Number	:	718-209-5465
Fax Number	:

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

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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