Healthcare Provider Details

I. General information

NPI: 1174406094
Provider Name (Legal Business Name): HALLE SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 ATLANTIC AVE FL 2
BROOKLYN NY
11201-5501
US

IV. Provider business mailing address

70 ATLANTIC AVE FL 2
BROOKLYN NY
11201-5501
US

V. Phone/Fax

Practice location:
  • Phone: 929-455-2500
  • Fax:
Mailing address:
  • Phone: 929-455-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number030390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: