Healthcare Provider Details

I. General information

NPI: 1881529428
Provider Name (Legal Business Name): QSP ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 GRAND AVE
BALDWIN NY
11510-3164
US

IV. Provider business mailing address

2280 GRAND AVE STE 312
BALDWIN NY
11510-3110
US

V. Phone/Fax

Practice location:
  • Phone: 617-652-0223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: QIANA SMITH
Title or Position: PSYCHIATRIST
Credential: DO
Phone: 617-652-0223