Provider Demographics
NPI:1508751108
Name:JR SMITH PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:JR SMITH PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-749-5804
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:SHELTER ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11964-1848
Mailing Address - Country:US
Mailing Address - Phone:631-749-5113
Mailing Address - Fax:631-749-5803
Practice Address - Street 1:13A EAST THOMAS STREET
Practice Address - Street 2:
Practice Address - City:SHELTER ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11964
Practice Address - Country:US
Practice Address - Phone:631-749-5113
Practice Address - Fax:631-749-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty