Provider Demographics
NPI:1417044751
Name:SMITH, DANIEL T (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8132B OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1500
Mailing Address - Country:US
Mailing Address - Phone:315-546-0285
Mailing Address - Fax:315-546-0289
Practice Address - Street 1:8132B OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1500
Practice Address - Country:US
Practice Address - Phone:315-546-0285
Practice Address - Fax:315-546-0289
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005860213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02299154Medicaid
NYJ400001535OtherMEDICARE PTAN
NYJ400001535OtherMEDICARE PTAN
U89133Medicare UPIN
NY02299154Medicaid