Basic Information
| Provider Information | |||||||||
| NPI: | 1548637416 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SIMONE | ||||||||
| FirstName: | JUSTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 S FRANKLIN TPKE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | RAMSEY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074462558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187670610 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1053 W BOSTON POST RD | ||||||||
| Address2: | |||||||||
| City: | MAMARONECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105433329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143810203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2015 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01799600 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 039213-01 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.