Jeannette Rose Gonzalez Simon, D.O.

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

244298 Issued in NY

Practice address

19 Hathaway LN
Verona, NJ 07044-2306

Phone

(917) 294-4620

NPI assigned

May 12, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jeannette Simon Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tristate Medical and Wellness, LLC

  • Multi-Specialty Clinic/Center
  • Verona, NJ
  • NPI 1932707452
  NPD

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

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1487972659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 HATHAWAY LN",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070442306",
            "telephone_number": "917-294-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 HATHAWAY LN",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070442306",
            "telephone_number": "917-294-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ SIMON",
        "first_name": "JEANNETTE",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-05-12",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NJ",
            "license": "25MB09786100",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NY",
            "license": "244298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANNETTE",
            "last_name": "SIMON",
            "credential": "D.O.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Toni Giovatto, LCSW
• Elizabeth Leder Giuffrida, M.S., CCC-SLP
• David Gluck, MS, OTR/L
• Amanda Nicole Godine, PA-C
• Marcelo Gomez, MSW
• Orlando V Gonzalez, M.D.
• Ryan William Goodell
• Karen Ann Gordon, MD
• Karen Gorman
• Robert T Gorman, M..D.

• Pediatric Gastroenterology Physician in Verona, NJ
• Providers in Verona, NJ by specialty
• Pediatric Gastroenterology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; 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.