Provider Demographics
NPI:1316946270
Name:SIMON, ALAN D (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1124 E RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3915
Mailing Address - Country:US
Mailing Address - Phone:201-689-9400
Mailing Address - Fax:201-689-9404
Practice Address - Street 1:1124 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3915
Practice Address - Country:US
Practice Address - Phone:201-689-9400
Practice Address - Fax:201-689-9404
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2014-06-05
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Provider Licenses
StateLicense IDTaxonomies
NJMA06924500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ040915WC0Medicare PIN
NJF80563Medicare UPIN