Provider Demographics
NPI:1275137762
Name:SMITH, GRACE RITA (AUD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:RITA
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 EAST 59TH STREET
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-434-4500
Mailing Address - Fax:
Practice Address - Street 1:110 EAST 59TH STREET
Practice Address - Street 2:SUITE 10A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1359
Practice Address - Country:US
Practice Address - Phone:212-434-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002954-01231H00000X
NY14000062843237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter