Divine Hubert Simon

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

NYCPS-P-35993 Issued in NY

Practice address

10030 Ditmars Blvd
East Elmhurst, NY 11369-1333

Phone

(929) 899-6706

NPI assigned

Aug 20, 2026

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1787184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1205742095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3665 BERTHA DR",
            "city": "BALDWIN",
            "state": "NY",
            "postal_code": "115105035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10030 DITMARS BLVD",
            "city": "EAST ELMHURST",
            "state": "NY",
            "postal_code": "113691333",
            "telephone_number": "929-899-6706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "DIVINE",
        "middle_name": "HUBERT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-08-20",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": "NY",
            "license": "NYCPS-P-35993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Shimonov, PMHNP-BC
• Akram Shuaib, PHARM.D.
• Tina Marie Sibilio, M.S.
• Georgia Sideris
• Carla S Siguenza, RN
• Jasbir Singh
• Lisa Sokoloff
• Felisha Ann Sorge
• Jhadira Alexandra Soto Chipana
• Paul Spatzner, DDS

• Peer Specialist in East Elmhurst, NY
• Providers in East Elmhurst, NY by specialty
• Peer Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; 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.