Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 035261 | NY |
NPI | 1023084274 |
---|---|
Provider Name | Dr. Michael James Smith |
First Address | Monroe, NY 10950 |
Second Address | Monroe, NY 10950-2613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 31/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00727284 | (05) | NY |
T49495 | (02) |