Individual
GEOFFREY SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1656 CHAMPLIN AVE, SUITE 203, UTICA, NY 13502-4830
(315) 738-0647
(315) 738-9719
Mailing address
PO BOX 765, NEW HARTFORD, NY 13413
(315) 737-1412
(315) 738-9719
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
105165
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00590047
—
NY
01
—
025299
MVP
NY
01
—
10032749
CDPHP
NY
01
—
5328149
AETNA
NY
Enumeration date
07/01/2005
Last updated
12/05/2011
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