Provider Demographics
NPI:1962857110
Name:SMITH, TYLER ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:ELLIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:240 E 38TH ST FL 13
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2708
Mailing Address - Country:US
Mailing Address - Phone:646-501-7500
Mailing Address - Fax:646-754-9593
Practice Address - Street 1:240 E 38TH ST FL 13
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2708
Practice Address - Country:US
Practice Address - Phone:646-501-7500
Practice Address - Fax:646-754-9593
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY3044862084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology