# DR. CHARLES JOSEPH SMUTNY III

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1912962473
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133NN1002X | Nutrition Education Nutritionist | 206232 | NY | — |
| 171100000X | Acupuncturist | 206232 | NY | — |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | 206232 | NY | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 206232 | NY | Yes |
| 208D00000X | General Practice Physician | 206232 | NY | — |
| 208VP0000X | Pain Medicine Physician | 206232 | NY | — |

## Other

- **Enumeration date:** 04/19/2006
- **Last updated:** 09/04/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01V30EN311 | MEDICARE PTAN | 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 |