Provider Demographics
NPI:1629398599
Name:SMITH, BRETT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:WILLIAM
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 1:216 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-741-0570
Mailing Address - Fax:516-741-8276
Practice Address - Street 1:259 FIRST STREET
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-741-0570
Practice Address - Fax:516-741-8276
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257141207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology