Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 216518 | NY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 216518-1 | NM |
NPI | 1174528145 |
---|---|
Provider Name | Dr. Thomas V Smallman |
First Address | Skaneateles, NY 13152-1301 |
Second Address | Skaneateles, NY 13152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 19/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01713895 | (05) | NY |
F66847 | (02) | NY |