Healthcare Provider Details

I. General information

NPI: 1740484112
Provider Name (Legal Business Name): JORDANA MARGARET SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 YORK AVE
NEW YORK NY
10021-5663
US

IV. Provider business mailing address

1305 YORK AVE FL 11
NEW YORK NY
10021-5663
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-2020
  • Fax: 646-962-0603
Mailing address:
  • Phone: 646-962-2020
  • Fax: 646-962-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT191275
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number46295
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number331719
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: