Provider Demographics
NPI:1588984538
Name:SIMON, MARGO D (MD)
Entity type:Individual
Prefix:DR
First Name:MARGO
Middle Name:D
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:198 E 121ST ST FL 5
Mailing Address - Street 2:JANIAN MEDICAL CARE/PPOH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3523
Mailing Address - Country:US
Mailing Address - Phone:212-801-3300
Mailing Address - Fax:
Practice Address - Street 1:198 E 121ST ST FL 5
Practice Address - Street 2:JANIAN MEDICAL CARE/PPOH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3523
Practice Address - Country:US
Practice Address - Phone:212-801-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT48674207Q00000X, 2084P0800X
NY264440207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY264440OtherSTATE LICENSE
CT48674OtherSTATE LICENSE