Individual
KYLE MATTHEW SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
340 HOWELLS RD, BAY SHORE, NY 11706-5322
(631) 666-1956
(631) 666-1957
Mailing address
340 HOWELLS RD, BAY SHORE, NY 11706-5322
(631) 666-1956
(631) 666-1957
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
308861
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
04/11/2018
Last updated
06/15/2021
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