Provider Demographics
NPI:1245492073
Name:SIMON, MANFRED (MD)
Entity type:Individual
Prefix:DR
First Name:MANFRED
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1807
Mailing Address - Country:US
Mailing Address - Phone:914-723-1114
Mailing Address - Fax:914-723-1114
Practice Address - Street 1:93 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1807
Practice Address - Country:US
Practice Address - Phone:914-723-1114
Practice Address - Fax:914-723-1114
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079606174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist