Basic Information
Provider Information
NPI: 1689089864
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIMKINS
FirstName: JESSICA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD MPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 800 WESTCHESTER AVE STE N715
Address2:  
City: RYE BROOK
State: NY
PostalCode: 105731376
CountryCode: US
TelephoneNumber: 9146075730
FaxNumber: 9144571195
Practice Location
Address1: 171 HUGUENOT ST
Address2:  
City: NEW ROCHELLE
State: NY
PostalCode: 108017760
CountryCode: US
TelephoneNumber: 9146074720
FaxNumber: 9146074721
Other Information
ProviderEnumerationDate: 06/25/2014
LastUpdateDate: 11/02/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/02/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X289695NYY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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