Provider Demographics
NPI:1124048236
Name:SIMOVITCH, RYAN W (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:W
Last Name:SIMOVITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22076
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2076
Mailing Address - Country:US
Mailing Address - Phone:561-657-4600
Mailing Address - Fax:561-694-3099
Practice Address - Street 1:300 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2711
Practice Address - Country:US
Practice Address - Phone:561-657-4600
Practice Address - Fax:561-657-4605
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94929207X00000X
FL94929207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB696ZMedicare PIN
149578Medicare UPIN
FL276953100Medicaid