Organization
TY SMITH NURSE PRACTITIONER ADULT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMARA Y SMITH (OWNER)
(516) 284-7521
Entity
Organization
Contact information
Practice address
76 S CENTRAL AVE STE 1A, VALLEY STREAM, NY 11580-5405
(516) 770-6102
Mailing address
1595 N CENTRAL AVE APT 39, VALLEY STREAM, NY 11580-1186
(516) 770-6102
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
10/09/2023
Last updated
01/27/2024
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