Provider Demographics
NPI:1417776725
Name:SIMSUANGCO, IRENEJOY SANTOS (LDO)
Entity type:Individual
Prefix:
First Name:IRENEJOY
Middle Name:SANTOS
Last Name:SIMSUANGCO
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2542
Mailing Address - Country:US
Mailing Address - Phone:631-345-0065
Mailing Address - Fax:631-345-0138
Practice Address - Street 1:750 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2542
Practice Address - Country:US
Practice Address - Phone:631-345-0065
Practice Address - Fax:631-345-0138
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9046156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician