Provider Demographics
NPI:1881820819
Name:SMITH, JEAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:B
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 1:175 EAST 62ND ST.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7626
Mailing Address - Country:US
Mailing Address - Phone:212-832-8216
Mailing Address - Fax:
Practice Address - Street 1:175 EAST 62ND ST.
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7626
Practice Address - Country:US
Practice Address - Phone:212-832-8216
Practice Address - Fax:212-753-7210
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081921-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D46633Medicare UPIN