Provider Demographics
NPI:1457031049
Name:SMYTH, CAROLINE MAY (NP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MAY
Last Name:SMYTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 JOHNSON PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1344
Mailing Address - Country:US
Mailing Address - Phone:516-512-3812
Mailing Address - Fax:
Practice Address - Street 1:2073 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2222
Practice Address - Country:US
Practice Address - Phone:516-781-9898
Practice Address - Fax:516-781-9702
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine