Healthcare Provider Details

I. General information

NPI: 1457587768
Provider Name (Legal Business Name): RITA ASARE SMITH R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 BAINBRIDGE AVE
BRONX NY
10458-4601
US

IV. Provider business mailing address

1915 MORRIS AVE APT. 1G
BRONX NY
10453-5920
US

V. Phone/Fax

Practice location:
  • Phone: 718-733-3854
  • Fax:
Mailing address:
  • Phone: 347-597-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number613667
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: