Provider Demographics
NPI:1275543704
Name:SMITH, DAVID C (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750-1804
Mailing Address - Country:US
Mailing Address - Phone:716-708-5005
Mailing Address - Fax:
Practice Address - Street 1:18 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750-1804
Practice Address - Country:US
Practice Address - Phone:716-708-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3343213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00724781Medicaid
387680Medicare ID - Type Unspecified
NY00724781Medicaid