Active NPI
Alfonso So Sim, MD
- Pediatrics Physician
- Brooklyn, NY
National Provider Identifier
1801882196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 126356
- Practice address
- 740 64TH St
Brooklyn, NY 11220-4714 - Phone
- (718) 439-2000
- Fax
- (718) 439-2196
- NPI assigned
- Sep 22, 2005
- Last updated
- Jul 8, 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 126356 | NY | Primary |
Addresses
Primary practice location
740 64TH St
Brooklyn, NY 11220-4714
Mailing address
7952 211TH St
Oakland Gardens, NY 11364-3226
Phone (718) 439-2000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00468539 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 126356 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Brooklyn Medical Group PC | Pediatrics | Past | Accepting new patients |
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.
-
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- New York, NY
- NPI 1689627184
Pediatrics
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801882196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7952 211TH ST",
"city": "OAKLAND GARDENS",
"state": "NY",
"postal_code": "113643226",
"telephone_number": "718-439-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "740 64TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112204714",
"telephone_number": "718-439-2000",
"fax_number": "718-439-2196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIM",
"first_name": "ALFONSO",
"middle_name": "SO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "126356",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00468539",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.