Provider Demographics
NPI:1285891291
Name:SMITH, JILL N (RT,LRT,M)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:RT,LRT,M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 COUNTY ROAD 47
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8832
Mailing Address - Country:US
Mailing Address - Phone:585-905-0698
Mailing Address - Fax:
Practice Address - Street 1:2926 COUNTY ROAD 47
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-8832
Practice Address - Country:US
Practice Address - Phone:585-905-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY790856247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist