=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174111496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARREN M. SMITH, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2021
-----------------------------------------------------
Last Update Date | 01/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 742 PARK AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-633-0627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1069 WASHINGTON AVE
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10803-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-471-0174
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DARREN M. SMITH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-633-0627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------