Individual
PHILIP SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
110 W 6TH ST, OSWEGO, NY 13126-2507
(315) 349-5511
Mailing address
8513 BAYRIDGE RD, CICERO, NY 13039-9234
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
012347
NY
Other
Enumeration date
09/25/2024
Last updated
01/06/2025
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