Provider Demographics
NPI:1386869972
Name:SIMON, IRIS (MS NPP BC)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MS NPP BC
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:MARLENE
Other - Last Name:HAUSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 GREYSTONE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4512
Mailing Address - Country:US
Mailing Address - Phone:516-766-0338
Mailing Address - Fax:
Practice Address - Street 1:55 GREYSTONE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4512
Practice Address - Country:US
Practice Address - Phone:516-766-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400559-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP12441Medicare UPIN
NY96N031Medicare PIN