Provider Demographics
NPI:1336498567
Name:SMOLOFF, TODD
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:SMOLOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 OCEAN PKWY
Mailing Address - Street 2:APT 5C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6146
Mailing Address - Country:US
Mailing Address - Phone:845-304-4966
Mailing Address - Fax:
Practice Address - Street 1:2510 OCEAN PKWY
Practice Address - Street 2:APT 5C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6146
Practice Address - Country:US
Practice Address - Phone:845-304-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY665529121171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor