MEDICARE: DR. SIMON MUAKA NZUZI DPM

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	213E00000X	Podiatrist	NOO3037	NY
2	213EP1101X	Primary Podiatric Medicine Podiatrist	N003037	NY
3	213ES0131X	Foot Surgery Podiatrist	N003037	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	#0276134	OTHER	NY	CIGNA-MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0046447	OTHER	NY	GHI PROVIDER NUMBER
3	115, 119, 65	OTHER	NY	FIDELIS
4	MPI:28980	OTHER	NY	UNITED HEALTH PLANS
5	SP13669	OTHER	NY	CENTER CARE PROVIDER NUMB
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	396200P	OTHER	NY	HIP PROVIDER NUMBER
8	0029644 P-64 P110	OTHER	NY	OXFORD PLANS
9	P34003SN	OTHER	NY	BLEU CROSS/BLEU SHIELD
10	P.3037-0	OTHER	NY	WORKER-COMPENSATION

General Provider Information

NPI Number	:	1467414896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON MUAKA NZUZI DPM

Provider Business Mailing Address
First Line	:	12118 LAURELTON PKWY
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-1047
Country	:	US
Telephone Number	:	212-410-8069
Fax Number	:	212-410-8440

Provider Business Practice Location Address
First Line	:	20507 HILLSIDE AVE
Second Line	:	SUITE 18
City	:	HOLLIS
State	:	NY
Zip	:	11423-2220
Country	:	US
Telephone Number	:	718-479-7993
Fax Number	:	212-410-8440

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	08/03/2012

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