Provider Demographics
NPI:1447668041
Name:SIMONE, ERICA STEPHANIE (ATC, OTC)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:STEPHANIE
Last Name:SIMONE
Suffix:
Gender:F
Credentials:ATC, OTC
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Mailing Address - Street 1:150 SOUTHFIELD AVE
Mailing Address - Street 2:1408
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:504 VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3534
Practice Address - Country:US
Practice Address - Phone:973-291-1980
Practice Address - Fax:973-694-2692
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT8202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer