Provider Demographics
NPI:1083980262
Name:SMITH, EDWARD III (RVS)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:SMITH
Suffix:III
Gender:M
Credentials:RVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 E 35TH ST
Mailing Address - Street 2:SUITE# 5M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4241
Mailing Address - Country:US
Mailing Address - Phone:718-813-7657
Mailing Address - Fax:
Practice Address - Street 1:1145 E 35TH ST
Practice Address - Street 2:SUITE# 5M
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4241
Practice Address - Country:US
Practice Address - Phone:718-813-7657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000585802471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography