Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 244016 | NY |
NPI | 1003979261 |
---|---|
Provider Name | Michael Louis Smith |
First Address | Philadelphia, PA 19107-4430 |
Second Address | New York, NY 10022-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02945820 | (05) | NY |