Healthcare Provider Details

I. General information

NPI: 1588751515
Provider Name (Legal Business Name): NEAL T. SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5973 WALWORTH RD
ONTARIO NY
14519-9592
US

IV. Provider business mailing address

PO BOX 368
ONTARIO NY
14519-0368
US

V. Phone/Fax

Practice location:
  • Phone: 315-524-2881
  • Fax: 315-524-2231
Mailing address:
  • Phone: 315-524-2881
  • Fax: 315-524-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number158704-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: