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NPI Code Detail

MEDICARE: ALFONSO SO SIM MD

MEDICARE: ALFONSO SO SIM 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
1208000000XPediatrics Physician126356NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801882196
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALFONSO SO SIM MD
Provider Business Mailing Address
First Line : 7952 211TH ST
Second Line :
City : OAKLAND GARDENS
State : NY
Zip : 11364-3226
Country : US
Telephone Number : 718-439-2000
Fax Number :
Provider Business Practice Location Address
First Line : 740 64TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11220-4714
Country : US
Telephone Number : 718-439-2000
Fax Number : 718-439-2196
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 07/08/2007

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