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NPI Code Detail

MEDICARE: ZOE DAKOTA SIMEONE ATC

MEDICARE: ZOE DAKOTA SIMEONE ATC
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
12255A2300XAthletic Trainer
22255A2300XAthletic Trainer004129NY

General Provider Information

NPI Number : 1912499039
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZOE DAKOTA SIMEONE ATC
Provider Business Mailing Address
First Line : 11 FARNUM ST
Second Line :
City : LYNBROOK
State : NY
Zip : 11563-3920
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2837 LONG BEACH RD
Second Line :
City : OCEANSIDE
State : NY
Zip : 11572-2233
Country : US
Telephone Number : 516-549-5080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2018
Last Update Date : 08/12/2023

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Directions to “ ZOE DAKOTA SIMEONE ATC” Practice Location

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