Individual
MITCHELL LYLE SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
579A CRANBURY RD, EAST BRUNSWICK, NJ 08816-5426
(732) 390-0040
(732) 390-1856
Mailing address
579A CRANBURY RD, EAST BRUNSWICK, NJ 08816-5426
(732) 390-0040
(732) 390-1856
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
25MA07729600
NJ
2085R0202X
Diagnostic Radiology Physician
25MA07729600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0035661
—
NJ
05
—
02597226
—
NY
Enumeration date
12/16/2005
Last updated
12/18/2025
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