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General NPI Number Information
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NPI Number | 1851361414
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Entity Type | Individual
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Provider Name | PETER SMITH D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 207 HALLOCK RD SUITE 4
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City | STONY BROOK
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State | NY
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Zip | 11790-3033
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Country | US
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Telephone | 631-689-2300
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Fax | 631-689-2078
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Provider Business Mailing Address
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Address Line | 207 HALLOCK RD SUITE 4
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City | STONY BROOK
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State | NY
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Zip | 11790-3033
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Country | US
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Telephone | 631-689-2300
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Fax | 631-689-2078
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N004433
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | PD1905
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License Number State | MA
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