Provider Demographics
NPI:1013363704
Name:SMITH, ERIC M
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 HEMPSTEAD TPKE BLDG R
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1856
Mailing Address - Country:US
Mailing Address - Phone:516-572-5166
Mailing Address - Fax:516-572-5174
Practice Address - Street 1:2251 HEMPSTEAD TPKE BLDG R
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1856
Practice Address - Country:US
Practice Address - Phone:516-572-5166
Practice Address - Fax:516-572-5174
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006681363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant