1427244243 NPI number — PROF. MICHAEL A SMITH ND,HHA,PCW,PNP

Table of content: PROF. MICHAEL A SMITH ND,HHA,PCW,PNP (NPI 1427244243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427244243 NPI number — PROF. MICHAEL A SMITH ND,HHA,PCW,PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
ND,HHA,PCW,PNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427244243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 2353
Provider Second Line Business Mailing Address:
UNIT 1 BOX 1781
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
10163-1781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-794-6416
Provider Business Mailing Address Fax Number:
917-794-6416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 E 105TH ST
Provider Second Line Business Practice Location Address:
09A
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-794-6416
Provider Business Practice Location Address Fax Number:
917-794-6416
Provider Enumeration Date:
09/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0704014 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372600000X , with the licence number: 85432 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 372600000X , with the licence number: PA023502Y , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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