NPIMap

Organization Active NPI

Northeast Orthopedics and Sports Medicine PLLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Nanuet, NY
National Provider Identifier
1073937579
Registry record updated Dec 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
NORTHEAST ORTHOPEDICS AND SPORTS MEDICINE PLLC
Practice address
507 Airport Executive Park
Nanuet, NY 10954-5238
Phone
(845) 262-5313
Fax
(845) 262-5330
NPI assigned
Feb 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jordan A Simon, MD
Title
MBR
Phone
(845) 262-5313

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X Primary

Addresses

Primary practice location

507 Airport Executive Park
Nanuet, NY 10954-5238

Mailing address

507 Airport Executive Park
Nanuet, NY 10954-5238
Phone (845) 262-5313

National Provider Directory

National Provider Directory

Locations

99 Dutch Hill Rd
Orangeburg, NY 10962
Phone (845) 355-9727

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481846400000",
    "number": "1073937579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 AIRPORT EXECUTIVE PARK",
            "city": "NANUET",
            "state": "NY",
            "postal_code": "109545238",
            "telephone_number": "845-262-5313",
            "fax_number": "845-262-5330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 AIRPORT EXECUTIVE PARK",
            "city": "NANUET",
            "state": "NY",
            "postal_code": "109545238",
            "telephone_number": "845-262-5313",
            "fax_number": "845-262-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ORTHOPEDICS AND SPORTS MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-05",
        "last_updated": "2016-12-16",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MBR",
        "authorized_official_telephone_number": "845-262-5313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nanuet, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.