Healthcare Provider Details

I. General information

NPI: 1528053964
Provider Name (Legal Business Name): LIZETTE J SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 AMSTERDAM AVE 4TH FLOOR
NEW YORK NY
10025-1737
US

IV. Provider business mailing address

1790 BROADWAY 3RD FLOOR
NEW YORK NY
10019-1412
US

V. Phone/Fax

Practice location:
  • Phone: 212-961-5500
  • Fax: 212-531-7640
Mailing address:
  • Phone: 212-315-0144
  • Fax: 212-315-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number225548
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: