Provider Demographics
NPI:1306892583
Name:FINK, SIMON D (MD)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:D
Last Name:FINK
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 1:5645 MAIN ST
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-445-0220
Mailing Address - Fax:718-939-1167
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:W-LL300
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-445-0220
Practice Address - Fax:718-939-1167
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104454208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00181599Medicaid
NYE39143Medicare UPIN
NY02017IMedicare ID - Type Unspecified
NY01166Medicare PIN
NY00181599Medicaid