Provider Demographics
NPI:1215027180
Name:SIMKHAEV, LARISA (PA)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:SIMKHAEV
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6325 SAUNDERS ST
Mailing Address - Street 2:APT. 2K
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2034
Mailing Address - Country:US
Mailing Address - Phone:718-920-2961
Mailing Address - Fax:718-920-2058
Practice Address - Street 1:MMC - DEPT. OF MEDICINE
Practice Address - Street 2:111 EAST 210TH STREET
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-2961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY007000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant