Provider Demographics
NPI:1699726737
Name:DE SIMONE, JEFFREY M (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:DE SIMONE
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1001 W FAYETTE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2866
Mailing Address - Country:US
Mailing Address - Phone:315-937-3433
Mailing Address - Fax:315-470-5859
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1651
Practice Address - Country:US
Practice Address - Phone:315-470-7364
Practice Address - Fax:315-470-5859
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY172879208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01482200Medicaid
NY01482200Medicaid
BB0437Medicare ID - Type Unspecified
F78572Medicare UPIN