MEDICARE: SANDRA 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	174400000X	Specialist		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	131708249-001	OTHER	NY	HEALTH FIRST
2	329	OTHER	NY	MONTE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	040401001680	OTHER	NY	CENTER CARE
5	263784	OTHER	NY	HEALTHNET
6	47173000	OTHER	NY	BRONX HEALTH PLAN
7	ANC 1649	OTHER	NY	OXFORD
8	G70211	OTHER	NY	EMPIRE BLUE CROSS SHIELD
9	557052	OTHER	NY	AETNA
10	H6549	OTHER	NY	HOMELINK

General Provider Information

NPI Number	:	1417019837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA SIMON

Provider Business Mailing Address
First Line	:	2150 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1406
Country	:	US
Telephone Number	:	718-892-6300
Fax Number	:	718-892-3107

Provider Business Practice Location Address
First Line	:	2150 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1406
Country	:	US
Telephone Number	:	718-892-6300
Fax Number	:	718-892-3107

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/09/2007

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Directions to “ SANDRA SIMON ” Practice Location

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