Provider Demographics
NPI:1821301375
Name:SMART HEALTH MEDICAL, P.C.
Entity Type:Organization
Organization Name:SMART HEALTH MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VI
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-258-2574
Mailing Address - Street 1:160 E 84TH ST
Mailing Address - Street 2:10L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2008
Mailing Address - Country:US
Mailing Address - Phone:646-258-2574
Mailing Address - Fax:
Practice Address - Street 1:83-45 DONGAN AVE
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11373-3755
Practice Address - Country:US
Practice Address - Phone:646-258-2574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211187207Q00000X
NY246652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty