Provider Demographics
NPI:1255375648
Name:SMITH, CRAIG R (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-342-3892
Mailing Address - Fax:212-342-5262
Practice Address - Street 1:177 FORT WASHINGTON AVE
Practice Address - Street 2:7-435 G.N.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:212-305-8312
Practice Address - Fax:212-305-0905
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1348161208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY821009Medicaid
NY821009Medicaid