Healthcare Provider Details

I. General information

NPI: 1336965888
Provider Name (Legal Business Name): ABAGAIL MARIE SMENTKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 TIMES SQ
NEW YORK NY
10036-6564
US

IV. Provider business mailing address

53 DEVONSHIRE WAY
HALFMOON NY
12065-3230
US

V. Phone/Fax

Practice location:
  • Phone: 518-300-0201
  • Fax:
Mailing address:
  • Phone: 518-300-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number036698
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: