Provider Demographics
NPI:1114027893
Name:SMITH, RICHARD F (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARKWAY FL 3
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1505
Mailing Address - Country:US
Mailing Address - Phone:914-232-5955
Mailing Address - Fax:914-206-4728
Practice Address - Street 1:15 PARKWAY FL 3
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-1505
Practice Address - Country:US
Practice Address - Phone:914-232-5955
Practice Address - Fax:914-206-4728
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215065204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004521Medicare ID - Type UnspecifiedMEDICARE ID
NYH13265Medicare UPIN