MEDICARE: AGNES SIMON RN

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	364ST0500X	Transplantation Clinical Nurse Specialist	788365-01	NY

General Provider Information

NPI Number	:	1538002712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNES SIMON RN

Provider Business Mailing Address
First Line	:	240 E 89TH ST APT D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-4355
Country	:	US
Telephone Number	:	917-940-2092
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6508
Country	:	US
Telephone Number	:	917-940-2092
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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