Provider Demographics
NPI:1154329472
Name:SIMON, STEVEN IRA (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:IRA
Last Name:SIMON
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 1:2270 KIMBALL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5139
Mailing Address - Country:US
Mailing Address - Phone:718-253-4550
Mailing Address - Fax:718-253-6430
Practice Address - Street 1:2270 KIMBALL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5139
Practice Address - Country:US
Practice Address - Phone:718-253-4550
Practice Address - Fax:718-253-6430
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136343207NS0135X
NY136343-11207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00600239Medicaid
NYC10117Medicare UPIN
NY00600239Medicaid