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NPI Code Detail

MEDICARE: DR. SCOTT MICHAEL SMUKALLA M.D.

MEDICARE: DR. SCOTT MICHAEL SMUKALLA 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
1390200000XStudent in an Organized Health Care Education/Training Program267953NY
2207RG0100XGastroenterology Physician267953NY

General Provider Information

NPI Number : 1821380726
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT MICHAEL SMUKALLA M.D.
Provider Business Mailing Address
First Line : 550 1ST AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10016-6402
Country : US
Telephone Number : 212-263-5506
Fax Number :
Provider Business Practice Location Address
First Line : 555 MADISON AVE FL 2
Second Line :
City : NEW YORK
State : NY
Zip : 10022-3418
Country : US
Telephone Number : 646-754-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2011
Last Update Date : 04/02/2021

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