Provider Demographics
NPI:1538185657
Name:SIMON, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
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 1:629 CRANBURY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4096
Mailing Address - Country:US
Mailing Address - Phone:732-254-6200
Mailing Address - Fax:732-254-7803
Practice Address - Street 1:53 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-1559
Practice Address - Country:US
Practice Address - Phone:732-254-6200
Practice Address - Fax:732-254-7803
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05520400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS1688640OtherMEDICARE ID-TYPE UNSPECIF
LP135OtherOXFORD
1025374019OtherCIGNA
NJ5545307Medicaid
1025374019OtherCIGNA