=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245603398
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALFORD A SMITH MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2015
-----------------------------------------------------
Last Update Date | 12/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 765 NOSTRAND AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11216-4203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-282-1570
-----------------------------------------------------
Fax | 347-561-6170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 150379
-----------------------------------------------------
City | KEW GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11415-0379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-763-6721
-----------------------------------------------------
Fax | 347-561-6170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALFORD ALEXANDER SMITH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 917-763-6721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------