Provider Demographics
NPI:1497953517
Name:SMITH, JOSEPH MALIK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MALIK
Last Name:SMITH
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 1:230-B MARY LOU AVENUE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1904
Mailing Address - Country:US
Mailing Address - Phone:914-457-2825
Mailing Address - Fax:
Practice Address - Street 1:GOOD SAMARITAN HOSPITAL - EMERGENCY DEPARTMENT
Practice Address - Street 2:255 LAFAYETTE AVENUE
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4869
Practice Address - Country:US
Practice Address - Phone:845-368-5030
Practice Address - Fax:845-368-5931
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY245226207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY245226Medicaid