Provider Demographics
NPI:1942528609
Name:SMITH, ROBERT G (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 AGAR AVE
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9326
Mailing Address - Country:US
Mailing Address - Phone:585-732-2998
Mailing Address - Fax:
Practice Address - Street 1:55 AGAR AVE
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9326
Practice Address - Country:US
Practice Address - Phone:585-732-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered