Basic Information
Provider Information
NPI: 1316936966
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIMPSON
FirstName: LAURENCE
MiddleName: STEPHEN
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 160 E 32ND ST
Address2: SUITE 103
City: NEW YORK
State: NY
PostalCode: 100166004
CountryCode: US
TelephoneNumber: 2126833328
FaxNumber: 2126830021
Practice Location
Address1: 160 E 32ND ST
Address2: SUITE 103
City: NEW YORK
State: NY
PostalCode: 100166004
CountryCode: US
TelephoneNumber: 2126833328
FaxNumber: 2126830021
Other Information
ProviderEnumerationDate: 10/17/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X033041NYY Dental ProvidersDentistGeneral Practice

No ID Information.


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