MEDICARE: ROBERT HENRY SMITH MD

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	2085R0202X	Diagnostic Radiology Physician	187318	NY
2	2085R0204X	Vascular & Interventional Radiology Physician	187318	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518920826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT HENRY SMITH MD

Provider Business Mailing Address
First Line	:	8900 VAN WYCK EXPY
Second Line	:	JAMAICA HOSPITAL MEDICAL CENTER DEPT RADIOLOGY
City	:	JAMAICA
State	:	NY
Zip	:	11418-2832
Country	:	US
Telephone Number	:	718-206-6127
Fax Number	:	631-206-7670

Provider Business Practice Location Address
First Line	:	8900 VAN WYCK EXPY
Second Line	:	JAMAICA HOSPITAL MEDICAL CENTER DEPT RADIOLOGY
City	:	JAMAICA
State	:	NY
Zip	:	11418-2832
Country	:	US
Telephone Number	:	718-206-6127
Fax Number	:	631-206-7670

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	03/23/2017

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