Provider Demographics
NPI:1154748093
Name:SIMMS, NEVILLE
Entity type:Individual
Prefix:
First Name:NEVILLE
Middle Name:
Last Name:SIMMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 NORTH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768
Mailing Address - Country:US
Mailing Address - Phone:631-335-8314
Mailing Address - Fax:631-262-9248
Practice Address - Street 1:73 COLUMBIA HEIGHTS
Practice Address - Street 2:APT.# GL1
Practice Address - City:BROOKLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:631-335-8314
Practice Address - Fax:718-807-4248
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist