Provider Demographics
NPI:1609845114
Name:SMITH, GERARD J (DC)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GILBERT AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5326
Mailing Address - Country:US
Mailing Address - Phone:631-724-1991
Mailing Address - Fax:631-724-1995
Practice Address - Street 1:20 GILBERT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5326
Practice Address - Country:US
Practice Address - Phone:631-724-1991
Practice Address - Fax:631-724-1995
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO6740111N00000X
NYX006740-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU33885Medicare UPIN
NYX49591Medicare PIN