Mitchell Jack Simon, D.M.D
Individual provider Active NPI General Practice Dentistry · Baldwin Harbor, NY
NPI 1821026600 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1821026600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 034526 (NY)
- Practice address
- 960 Atlantic Ave
Baldwin Harbor, NY 11510-4241 - Phone
- (516) 377-1818
- Fax
- (515) 377-1831
- NPI assigned
- Jun 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034526 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Simon Dentistry PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 034526 | NY | Yes |
Addresses
Primary practice location
960 Atlantic Ave
Baldwin Harbor, NY 11510-4241
Mailing address
960 Atlantic Ave
Baldwin Harbor, NY 11510-4241
Phone (516) 377-1818
Other names
- Dr. Mitchell J Simon
Other providers in Baldwin Harbor, NY
All providers in Baldwin Harbor, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.