Provider Demographics
NPI:1275758526
Name:SMILEY, LAWRENCE A (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:SMILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6533 LANDINGS CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-4078
Mailing Address - Country:US
Mailing Address - Phone:516-698-1734
Mailing Address - Fax:516-496-8858
Practice Address - Street 1:175 I U WILLETS RD STE 2B
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1342
Practice Address - Country:US
Practice Address - Phone:516-442-4444
Practice Address - Fax:516-496-8858
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158862208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63458Medicare UPIN
61D00Medicare ID - Type Unspecified