Provider Demographics
NPI:1992767388
Name:SIMON, ANDREW L (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:459 JACK MARTIN BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7724
Mailing Address - Country:US
Mailing Address - Phone:732-840-0900
Mailing Address - Fax:732-840-0912
Practice Address - Street 1:459 JACK MARTIN BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7724
Practice Address - Country:US
Practice Address - Phone:732-840-0900
Practice Address - Fax:732-840-0912
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05112300208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7104406OtherCIGNA
NJE36485Medicare UPIN
NJ7104406OtherCIGNA