Provider Demographics
NPI:1598941379
Name:ROBERT S. SMITH
Entity Type:Organization
Organization Name:ROBERT S. SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRATITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-373-1775
Mailing Address - Street 1:3715 MAIN ST
Mailing Address - Street 2:#306
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3618
Mailing Address - Country:US
Mailing Address - Phone:203-373-1775
Mailing Address - Fax:
Practice Address - Street 1:3715 MAIN ST
Practice Address - Street 2:#306
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3618
Practice Address - Country:US
Practice Address - Phone:203-373-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTP00351332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4275120001Medicare NSC