MEDICARE: SIMON SANCHEZ, PHYSICIAN, PC

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1639369945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMON SANCHEZ, PHYSICIAN, PC

Provider Business Mailing Address
First Line	:	1991 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7936
Country	:	US
Telephone Number	:	631-969-9515
Fax Number	:	631-969-9517

Provider Business Practice Location Address
First Line	:	1991 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7936
Country	:	US
Telephone Number	:	631-969-9515
Fax Number	:	631-969-9517

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SIMON SANCHEZ
Credential	:	MD
Telephone Number	:	631-969-9515

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	08/09/2007

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