Provider Demographics
NPI:1417049941
Name:SIMMERMAN, STEVEN JON (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JON
Last Name:SIMMERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 WOODBURY GLASSBORO RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4559
Mailing Address - Country:US
Mailing Address - Phone:856-589-1288
Mailing Address - Fax:856-589-3437
Practice Address - Street 1:415 WOODBURY GLASSBORO RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4559
Practice Address - Country:US
Practice Address - Phone:856-589-1288
Practice Address - Fax:856-589-3437
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00275400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1638505Medicaid
NJ1638505Medicaid
NJT77701Medicare UPIN