Provider Demographics
NPI:1700165990
Name:SMITH ALLERGY AND ASTHMA OF CENTRAL NEW YORK PLLC
Entity Type:Organization
Organization Name:SMITH ALLERGY AND ASTHMA OF CENTRAL NEW YORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-684-6115
Mailing Address - Street 1:88 TIOGA AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2858
Mailing Address - Country:US
Mailing Address - Phone:607-684-6115
Mailing Address - Fax:607-684-6120
Practice Address - Street 1:88 E TIOGA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2858
Practice Address - Country:US
Practice Address - Phone:607-684-6115
Practice Address - Fax:607-684-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205695207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01748145Medicaid