Active NPI
Simon D Marshall, CASAC
- Addiction (Substance Use Disorder) Counselor
- Elmhurst, NY
National Provider Identifier
1669657334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 020578
- Practice address
- 80TH St & 41St Ave
Elmhurst, NY 11373-1329 - Phone
- (718) 334-3900
- Fax
- (718) 334-5958
- NPI assigned
- Dec 31, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 020578 | NY | Primary |
Addresses
Primary practice location
80TH St & 41St Ave
Elmhurst, NY 11373-1329
Mailing address
7901 Broadway
Managed Care, D1-01
Elmhurst, NY 11373-1329
Phone (718) 334-1921
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020578 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199059200000",
"number": "1669657334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7901 BROADWAY",
"address_2": "MANAGED CARE, D1-01",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113731329",
"telephone_number": "718-334-1921",
"fax_number": "718-334-3432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80TH ST & 41ST AVE",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113731329",
"telephone_number": "718-334-3900",
"fax_number": "718-334-5958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSHALL",
"first_name": "SIMON",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "CASAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-31",
"last_updated": "2007-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "020578",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.