Healthcare Provider Details

I. General information

NPI: 1154527281
Provider Name (Legal Business Name): PAUL T SMITH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 LEXINGTON AVE
NEW YORK NY
10021-5107
US

IV. Provider business mailing address

943 LEXINGTON AVE
NEW YORK NY
10021-5107
US

V. Phone/Fax

Practice location:
  • Phone: 212-396-4077
  • Fax: 212-396-1034
Mailing address:
  • Phone: 212-396-4077
  • Fax: 212-396-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number194625
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number194625
License Number StateNY

VIII. Authorized Official

Name: DR. PAUL TODD SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 212-396-4077