Provider Demographics
NPI:1508864752
Name:SMITH, ARDEN (DPM)
Entity Type:Individual
Prefix:
First Name:ARDEN
Middle Name:
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 1:55-31 69TH ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1806
Mailing Address - Country:US
Mailing Address - Phone:718-639-0499
Mailing Address - Fax:718-639-2268
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:718-639-0499
Practice Address - Fax:718-639-2268
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002991213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00436911Medicaid
T31818Medicare UPIN
NY00436911Medicaid