Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2875 | NY |
NPI | 1164562039 |
---|---|
Provider Name | Dr. Michael C Smatt |
First Address | New York, NY 10017-6304 |
Second Address | New York, NY 10017-6304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 09/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T75225 | (02) | NY |