Provider Demographics
NPI:1164736625
Name:PEDRO SMUKLER
Entity Type:Organization
Organization Name:PEDRO SMUKLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SMUKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-804-9722
Mailing Address - Street 1:30 DE KOVEN CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1708
Mailing Address - Country:US
Mailing Address - Phone:718-388-5770
Mailing Address - Fax:718-975-3395
Practice Address - Street 1:88 SEIGEL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-3203
Practice Address - Country:US
Practice Address - Phone:718-388-5770
Practice Address - Fax:718-975-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004149332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01007390Medicaid
NYP4409Medicare PIN