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Individual
DR. CHARLES JOSEPH SMUTNY III
Active
Individual
DR. CHARLES JOSEPH SMUTNY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
206232
NY
171100000X
Acupuncturist
206232
NY
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
206232
NY
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
206232
NY
208D00000X
General Practice Physician
206232
NY
208VP0000X
Pain Medicine Physician
206232
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01V30EN311
MEDICARE INTERUM INDIVPIN
NY
01
—
1639358799
GROUP NPI
NY
01
—
1912962473
INDIVIDUAL NPI
NY
01
—
206232
NY STATE LICENSE #
NY
01
—
62296658
INDIVIDUAL MEDICARE PIN
NY
01
—
WEN311
MEDICARE GROUP PIN
NY
Enumeration date
04/19/2006
Last updated
09/04/2014
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