Healthcare Provider Details

I. General information

NPI: 1326710864
Provider Name (Legal Business Name): JENNIFER LYNN SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE STE M100
NEW HYDE PARK NY
11042-2062
US

IV. Provider business mailing address

34 MAYFAIR RD
NESCONSET NY
11767-2609
US

V. Phone/Fax

Practice location:
  • Phone: 516-472-3650
  • Fax:
Mailing address:
  • Phone: 516-459-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF383314-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: