Provider Demographics
NPI:1932284569
Name:SMITH, BRIGETTE (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:BRIGETTE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MRS
Other - First Name:BRIGETTE
Other - Middle Name:
Other - Last Name:SLOMOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2420 RIDGEWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626
Mailing Address - Country:US
Mailing Address - Phone:585-227-4000
Mailing Address - Fax:585-227-4003
Practice Address - Street 1:2615 CULVER ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609
Practice Address - Country:US
Practice Address - Phone:585-336-5320
Practice Address - Fax:585-336-9114
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009396363AS0400X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03057201Medicaid
NYJ400002341Medicare UPIN
NYPA0187Medicare ID - Type Unspecified
NY03057201Medicaid
NYQ11354Medicare UPIN