Healthcare Provider Details

I. General information

NPI: 1508751108
Provider Name (Legal Business Name): JR SMITH PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13A EAST THOMAS STREET
SHELTER ISLAND NY
11964
US

IV. Provider business mailing address

PO BOX 1848
SHELTER ISLAND NY
11964-1848
US

V. Phone/Fax

Practice location:
  • Phone: 631-749-5113
  • Fax: 631-749-5803
Mailing address:
  • Phone: 631-749-5113
  • Fax: 631-749-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL WILLIAM SMITH
Title or Position: CEO/PRESIDENT
Credential:
Phone: 631-749-5804