MEDICARE: MR. TODD SMOLOFF

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	171W00000X	Contractor	665529121	NY

General Provider Information

NPI Number	:	1336498567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD SMOLOFF

Provider Business Mailing Address
First Line	:	2510 OCEAN PKWY
Second Line	:	APT 5C
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6146
Country	:	US
Telephone Number	:	845-304-4966
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 OCEAN PKWY
Second Line	:	APT 5C
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6146
Country	:	US
Telephone Number	:	845-304-4966
Fax Number	:

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

Provider Enumeration Date	:	09/04/2012
Last Update Date	:	09/04/2012

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Directions to “ MR. TODD SMOLOFF ” Practice Location

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