Provider Demographics
NPI:1548281538
Name:GERALD T SIMMONS
Entity type:Organization
Organization Name:GERALD T SIMMONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-342-7360
Mailing Address - Street 1:11 4TH AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1852
Mailing Address - Country:US
Mailing Address - Phone:315-342-7360
Mailing Address - Fax:315-342-7620
Practice Address - Street 1:11 4TH AVE
Practice Address - Street 2:SUITE F
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1852
Practice Address - Country:US
Practice Address - Phone:315-342-7360
Practice Address - Fax:315-342-7620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2116251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0557Medicare PIN
NYH07343Medicare UPIN