MEDICARE: DR. HEROLD 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	207RN0300X	Nephrology Physician	175968	NY
2	207R00000X	Internal Medicine Physician	175968	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	:	1427034974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEROLD SIMON

Provider Business Mailing Address
First Line	:	328 ARKANSAS DR
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-1804
Country	:	US
Telephone Number	:	516-561-3040
Fax Number	:	718-240-0564

Provider Business Practice Location Address
First Line	:	672 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2210
Country	:	US
Telephone Number	:	718-940-0400
Fax Number	:	718-940-8327

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	10/22/2024

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Directions to “ DR. HEROLD SIMON ” Practice Location

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