Provider Demographics
NPI:1447968466
Name:SIMCHAK, PHILIP JAMIESON
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JAMIESON
Last Name:SIMCHAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ECKFORD ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-3245
Mailing Address - Country:US
Mailing Address - Phone:202-215-8763
Mailing Address - Fax:
Practice Address - Street 1:155 ECKFORD ST APT 1R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-3245
Practice Address - Country:US
Practice Address - Phone:202-215-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011775225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty