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NPI Code Detail

MEDICARE: MR. JAY SMITH

MEDICARE: MR. JAY 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
1103K00000XBehavior Analyst004774NY

General Provider Information

NPI Number : 1912404740
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAY SMITH
Provider Business Mailing Address
First Line : 500 BI COUNTY BLVD STE 450
Second Line :
City : FARMINGDALE
State : NY
Zip : 11735-3995
Country : US
Telephone Number : 718-264-1640
Fax Number :
Provider Business Practice Location Address
First Line : 500 BI COUNTY BLVD STE 450
Second Line :
City : FARMINGDALE
State : NY
Zip : 11735-3995
Country : US
Telephone Number : 718-264-1640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2018
Last Update Date : 04/06/2026

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Directions to “ MR. JAY SMITH ” Practice Location

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