Provider Demographics
NPI:1851397053
Name:SMITH, HOWARD GARY (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:GARY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 67TH ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5930
Mailing Address - Country:US
Mailing Address - Phone:860-212-6723
Mailing Address - Fax:
Practice Address - Street 1:145 W 67TH ST APT 4C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5930
Practice Address - Country:US
Practice Address - Phone:860-212-6723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035460207YP0228X
NY266912207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00135460400Medicaid
B72761Medicare ID - Type Unspecified
CT00135460400Medicaid