MEDICARE: DR. ANGELA LANTZ SMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	216614	NY

General Provider Information

NPI Number	:	1063421329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA LANTZ SMITH M.D.

Provider Business Mailing Address
First Line	:	603 W 111TH ST
Second Line	:	#4E
City	:	NEW YORK
State	:	NY
Zip	:	10025-1800
Country	:	US
Telephone Number	:	347-752-7359
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 W 180TH ST
Second Line	:	JBFCS
City	:	NEW YORK
State	:	NY
Zip	:	10033-5807
Country	:	US
Telephone Number	:	212-795-9888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	01/28/2009

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