Individual
DR. PETER SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
207 HALLOCK RD, SUITE 4, STONY BROOK, NY 11790-3033
(631) 689-2300
(631) 689-2078
Mailing address
207 HALLOCK RD, SUITE 4, STONY BROOK, NY 11790-3033
(631) 689-2300
(631) 689-2078
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
N004433
NY
213ES0000X
Sports Medicine Podiatrist
PD1905
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01895183
—
NY
01
—
10259
VYTRA
NY
01
—
6364966004
CIGNA
NY
01
—
NYB002451
SUBMITTER ID
NY
01
—
P1911509
OXFORD
NY
01
—
PO 44330
WORKERS COMPENSATION
NY
Enumeration date
01/25/2006
Last updated
02/12/2008
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