MEDICARE: JENNIFER L SMITH MD PLLC

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	2084N0400X	Neurology Physician	244012-1	NY

General Provider Information

NPI Number	:	1184955189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER L SMITH MD PLLC

Provider Business Mailing Address
First Line	:	1 KIRKLAND AVE APT 302
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-1426
Country	:	US
Telephone Number	:	315-381-3402
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 KIRKLAND AVE APT 302
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-1426
Country	:	US
Telephone Number	:	315-381-3402
Fax Number	:	315-732-2315

Authorized Official
Title or Position	:	DOCTOR AND OWNER
Name	:	JENNIFER L SMITH
Credential	:	MD
Telephone Number	:	315-381-3402

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	01/15/2010

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