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General NPI Number Information
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NPI Number | 1366250409
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Entity Type | Organization
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Legal Business Name | SMITH NURSE PRACTITIONER IN FAMILY HEALTH P.C.
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 10 OLD RIVERHEAD RD UNIT A
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City | WESTHAMPTON BEACH
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State | NY
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Zip | 11978-1460
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Country | US
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Telephone | 631-523-7826
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Fax |
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Provider Business Mailing Address
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Address Line | 336 NICOLLS RD
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City | DEER PARK
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State | NY
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Zip | 11729-1806
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Country | US
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Telephone | 631-523-7826
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOREEN SMITH
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Credential | DNP
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Telephone | 631-523-7826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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