Provider Demographics
NPI:1376605923
Name:SMITH, REGINA D (NP)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:100 ASCH LOOP
Mailing Address - Street 2:APT. 24-F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4010
Mailing Address - Country:US
Mailing Address - Phone:718-671-7764
Mailing Address - Fax:212-423-8121
Practice Address - Street 1:1901 1ST AVE RM 4B5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-6336
Practice Address - Fax:212-423-8121
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF360007363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health