Healthcare Provider Details

I. General information

NPI: 1316939655
Provider Name (Legal Business Name): JENNIFER A SMITH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 ORCHARD PARK ROAD
WEST SENECA NY
14224
US

IV. Provider business mailing address

3050 ORCHARD PARK ROAD
WEST SENECA NY
14224
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-5222
  • Fax: 716-675-9329
Mailing address:
  • Phone: 716-675-5222
  • Fax: 716-675-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0079861
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number007986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: