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General NPI Number Information
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NPI Number | 1952344673
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Entity Type | Individual
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Provider Name | STEPHEN SMIRLOCK DPM
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 1000 HIGH ST
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City | PORT CHESTER
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State | NY
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Zip | 10573-4402
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Country | US
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Telephone | 917-747-1749
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Fax | 718-724-1889
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Provider Business Mailing Address
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Address Line | 136A SUNFLOWER DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-2461
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Country | US
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Telephone | 917-747-1749
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Fax | 718-724-1889
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 25MD00166100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N0022322
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License Number State | NY
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