Healthcare Provider Details

I. General information

NPI: 1508772526
Provider Name (Legal Business Name): BENJAMIN MICHAEL SMITH CNM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 W 49TH ST APT 2GG
NEW YORK NY
10019-7919
US

IV. Provider business mailing address

393 W 49TH ST APT 2GG
NEW YORK NY
10019-7919
US

V. Phone/Fax

Practice location:
  • Phone: 423-358-9749
  • Fax:
Mailing address:
  • Phone: 423-358-9749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: