Provider Demographics
NPI:1215921291
Name:SIMON, JUDITH (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 N GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4950
Mailing Address - Country:US
Mailing Address - Phone:732-741-1902
Mailing Address - Fax:732-741-1919
Practice Address - Street 1:21 N GILBERT ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4950
Practice Address - Country:US
Practice Address - Phone:732-741-1902
Practice Address - Fax:732-741-1919
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD63625207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
880820Medicare ID - Type Unspecified
G30472Medicare UPIN