Provider Demographics
NPI:1427244243
Name:SMITH, MICHAEL A (ND,HHA,PCW,PNP)
Entity type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:ND,HHA,PCW,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 2353
Mailing Address - Street 2:UNIT 1 BOX 1781
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:10163-1781
Mailing Address - Country:US
Mailing Address - Phone:917-794-6416
Mailing Address - Fax:917-794-6416
Practice Address - Street 1:420 E 105TH ST
Practice Address - Street 2:09A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5104
Practice Address - Country:US
Practice Address - Phone:917-794-6416
Practice Address - Fax:917-794-6416
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-16
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07040141041C0700X
NY85432372600000X
PAPA023502Y372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical