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NPI Code Detail

MEDICARE: SCOTT P. SMITH PH.D.

MEDICARE: SCOTT P. SMITH PH.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
1103TC0700XClinical Psychologist014485NY

General Provider Information

NPI Number : 1831478171
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT P. SMITH PH.D.
Provider Business Mailing Address
First Line : 303 MERRICK RD
Second Line : SUITE 204
City : LYNBROOK
State : NY
Zip : 11563-2501
Country : US
Telephone Number : 800-725-6280
Fax Number : 800-725-6380
Provider Business Practice Location Address
First Line : 7005 35TH AVE
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-3970
Country : US
Telephone Number : 718-662-5100
Fax Number : 718-662-5102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2011
Last Update Date : 08/04/2011

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