Provider Demographics
NPI:1548593551
Name:SMITH, VIVIAN VICTORIA
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:VICTORIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:11 PENN PLZ
Mailing Address - Street 2:SUITE B100
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2006
Mailing Address - Country:US
Mailing Address - Phone:917-658-9599
Mailing Address - Fax:
Practice Address - Street 1:11 PENN PLZ
Practice Address - Street 2:SUITE B100
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2006
Practice Address - Country:US
Practice Address - Phone:917-658-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor