Provider Demographics
NPI:1962767616
Name:SIMON, CHAIM MOSHE
Entity type:Individual
Prefix:MR
First Name:CHAIM
Middle Name:MOSHE
Last Name:SIMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 47TH ST # STREETA4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2830
Mailing Address - Country:US
Mailing Address - Phone:718-781-7295
Mailing Address - Fax:
Practice Address - Street 1:973 47TH ST # STREETA4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2830
Practice Address - Country:US
Practice Address - Phone:718-781-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000X- SPECIALIOtherTEACHER