Provider Demographics
NPI:1548334121
Name:SIMONS, ANITA (OTR, CHT)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:SIMONS
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2928
Mailing Address - Country:US
Mailing Address - Phone:212-371-2996
Mailing Address - Fax:212-980-1699
Practice Address - Street 1:300 E 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2928
Practice Address - Country:US
Practice Address - Phone:212-371-2996
Practice Address - Fax:212-980-1699
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00204174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0253940001Medicare NSC