Provider Demographics
NPI:1851069082
Name:SMITH, NICHOLAS A (PA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3361 N SHULER RD
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:NY
Mailing Address - Zip Code:14805-9740
Mailing Address - Country:US
Mailing Address - Phone:607-703-9409
Mailing Address - Fax:
Practice Address - Street 1:101 DATES DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1342
Practice Address - Country:US
Practice Address - Phone:607-274-4296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant