Provider Demographics
NPI:1326883497
Name:SMIT, JAKOB W (ATS)
Entity type:Individual
Prefix:MR
First Name:JAKOB
Middle Name:W
Last Name:SMIT
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:134 YOUNGBLOOD RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1945
Mailing Address - Country:US
Mailing Address - Phone:845-741-2089
Mailing Address - Fax:
Practice Address - Street 1:134 YOUNGBLOOD RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-1945
Practice Address - Country:US
Practice Address - Phone:845-741-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer