MEDICARE: DOROTHY J SMITH

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	163W00000X	Registered Nurse	651506	NY

General Provider Information

NPI Number	:	1639435928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY J SMITH

Provider Business Mailing Address
First Line	:	660 EMPIRE BLVD
Second Line	:	APT 7A
City	:	BROOKLYN
State	:	NY
Zip	:	11213-5254
Country	:	US
Telephone Number	:	718-771-2389
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 EMPIRE BLVD
Second Line	:	APT 7A
City	:	BROOKLYN
State	:	NY
Zip	:	11213-5254
Country	:	US
Telephone Number	:	718-771-2389
Fax Number	:

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

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	04/11/2012

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