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General NPI Number Information
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NPI Number | 1245102482
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Entity Type | Individual
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Provider Name | COLLIE DELROY SMITH CRPA
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Gender | Male
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 928 BROADWAY STE 403
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City | NEW YORK
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State | NY
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Zip | 10010-8151
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Country | US
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Telephone | 212-481-1055
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Fax | 212-481-7374
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Provider Business Mailing Address
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Address Line | 2525 OLINVILLE AVE APT 3C
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City | BRONX
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State | NY
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Zip | 10467-7407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | CRPA-6640
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License Number State | NY
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