Provider Demographics
NPI:1124095328
Name:SIMONS, WENDY ALEXANDRA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ALEXANDRA
Last Name:SIMONS
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:75 WASHINGTON VALLEY RD
Mailing Address - Street 2:CN 753 #502
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-2119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:465 NEW DORP LN
Practice Address - Street 2:SUITE S-117
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4902
Practice Address - Country:US
Practice Address - Phone:718-987-0128
Practice Address - Fax:718-987-0223
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2015-02-10
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Provider Licenses
StateLicense IDTaxonomies
NY002049-1363A00000X
NJ25MP00128400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant