Basic Information
| Provider Information | |||||||||
| NPI: | 1013213479 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARDAKH | ||||||||
| FirstName: | SIMON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550 | ||||||||
| Address2: | 2 CATHERINE ST PARK SLOPE ANESTHESIA ASSOCIATES, PC | ||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457902614 | ||||||||
| FaxNumber: | 8457902613 | ||||||||
| Practice Location | |||||||||
| Address1: | 506 6TH ST | ||||||||
| Address2: | NY METHODIST HOSPITAL | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187803279 | ||||||||
| FaxNumber: | 8457902613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2011 | ||||||||
| LastUpdateDate: | 01/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 269292 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 269292-1 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.