MEDICARE: MS. PATRICIA J. SMITH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F336655	NY

General Provider Information

NPI Number	:	1396037073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA J. SMITH FNP

Provider Business Mailing Address
First Line	:	4022 DE REIMER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2321
Country	:	US
Telephone Number	:	917-330-1160
Fax Number	:	347-341-5778

Provider Business Practice Location Address
First Line	:	4022 DE REIMER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2321
Country	:	US
Telephone Number	:	917-330-1160
Fax Number	:	347-341-5778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	05/12/2011

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