Provider Demographics
NPI:1144890542
Name:SIMON, RANDY NEIL (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:NEIL
Last Name:SIMON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 TREEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2411
Mailing Address - Country:US
Mailing Address - Phone:516-457-4777
Mailing Address - Fax:
Practice Address - Street 1:400 E 56TH ST OFC 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4339
Practice Address - Country:US
Practice Address - Phone:212-257-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027994001223E0200X
FLDN243291223E0200X
NY0618391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty