Provider Demographics
NPI:1639107980
Name:SMITH, ALYSON W (MD)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:W
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 1:4422 3RD AVE
Mailing Address - Street 2:ST BARNABAS HOSPITAL-DEPT PEDIATRICS
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2545
Mailing Address - Country:US
Mailing Address - Phone:718-960-9331
Mailing Address - Fax:
Practice Address - Street 1:2385 ARTHUR AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-8184
Practice Address - Country:US
Practice Address - Phone:718-220-9755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237223208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03248708Medicaid