Provider Demographics
NPI:1629432760
Name:SMITH, ROBIN (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 5TH AVE
Mailing Address - Street 2:SUITE 8H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2651
Mailing Address - Country:US
Mailing Address - Phone:917-691-7409
Mailing Address - Fax:212-656-1933
Practice Address - Street 1:420 LEXINGTON AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170-0002
Practice Address - Country:US
Practice Address - Phone:212-584-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211661208800000X
FLME77460208800000X
TXK7618208800000X
DEC10004448208800000X
CT038592208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC10004448OtherLICENSE
FLME77460OtherLICENSE
TXK7618OtherLICENSE
NY211661OtherLICENSE
CT038592OtherLICENSE