Individual
AARON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
460 BRIELLE AVE, BUILDING H, STATEN ISLAND, NY 10314
(718) 412-3155
(718) 816-1868
Mailing address
17212 133RD AVE, JAMAICA, NY 11434
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
27067
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
YM68601W
—
NY
Enumeration date
04/20/2017
Last updated
04/20/2017
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