Individual provider Active NPI

Lauren Elizabeth Simoniello

  • Psychiatric/Mental Health Nurse Practitioner
  • Syosset, NY
National Provider Identifier
1528775046
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F405955-01 Issued in NY
Practice address
175 Jericho Tpke
Syosset, NY 11791-4532
Phone
(516) 464-3006
NPI assigned
Nov 3, 2022
Last updated
Sep 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F405955-01 NY Primary
Psychiatric/Mental Health Registered Nurse 163WP0808X 745146 NY

Addresses

Primary practice location

175 Jericho Tpke
Syosset, NY 11791-4532

Mailing address

175 Jericho Tpke
Syosset, NY 11791-4532

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241007001828 NY Practitioner - Nurse Practitioner 8426589078 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
745146NYMDPsychiatric/Mental Health Registered Nurse
F405955-01NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mind Over Matter NP in Psychiatry and Family Health P.C. CurrentSince Oct 1, 2024 Accepting new patients

Locations

175 Jericho Tpke
Ste 117
Syosset, NY 11791
Phone (516) 496-9041

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1667433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1528775046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 JERICHO TPKE",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117914532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 JERICHO TPKE",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117914532",
            "telephone_number": "516-464-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONIELLO",
        "first_name": "LAUREN",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-03",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F405955-01",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NY",
            "license": "745146",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syosset, NY

Sources for this page

Verify at the official NPI Registry.