Provider Demographics
NPI:1144249160
Name:SOBO, SIMON B (MD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:B
Last Name:SOBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SIMON
Other - Middle Name:B
Other - Last Name:SOBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 ASPETUCK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2842
Mailing Address - Country:US
Mailing Address - Phone:860-355-0314
Mailing Address - Fax:203-270-3752
Practice Address - Street 1:1 ASPETUCK AVE
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2842
Practice Address - Country:US
Practice Address - Phone:860-355-0314
Practice Address - Fax:203-270-3752
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0230532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD02433Medicare UPIN