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General NPI Number Information
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NPI Number | 1912788613
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Entity Type | Organization
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Legal Business Name | TY SMITH NURSE PRACTITIONER ADULT
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 01/27/2024
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Provider Practice Location Address
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Address Line | 76 S CENTRAL AVE STE 1A
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City | VALLEY STREAM
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State | NY
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Zip | 11580-5405
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Country | US
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Telephone | 516-770-6102
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Fax |
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Provider Business Mailing Address
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Address Line | 1595 N CENTRAL AVE APT 39
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City | VALLEY STREAM
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State | NY
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Zip | 11580-1186
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Country | US
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Telephone | 516-770-6102
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TAMARA Y SMITH
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Credential |
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Telephone | 516-284-7521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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