Healthcare Provider Details

I. General information

NPI: 1811927270
Provider Name (Legal Business Name): DONALD SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6504
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1030
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-5586
  • Fax: 212-410-7196
Mailing address:
  • Phone: 212-241-7651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number108930
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number108930
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: