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1669479374

NPI Code Detail

MEDICARE: MICHAEL BRADLEY SIMON MD

MEDICARE: MICHAEL BRADLEY SIMON MD

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	207L00000X	Anesthesiology Physician	D0062365	MD
2	207L00000X	Anesthesiology Physician	197187	NY
3	207L00000X	Anesthesiology Physician	ME124285	FL
4	207L00000X	Anesthesiology Physician	MD428861	PA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669479374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BRADLEY SIMON MD

Provider Business Mailing Address
First Line	:	68 S SERVICE RD
Second Line	:	SUITE 350
City	:	MELVILLE
State	:	NY
Zip	:	11747-2354
Country	:	US
Telephone Number	:	516-945-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 READE PL
Second Line	:	ANESTHESIA DEPARTMENT
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12601-3947
Country	:	US
Telephone Number	:	845-431-5629
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/18/2026

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Directions to “ MICHAEL BRADLEY SIMON MD” Practice Location

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