Individual
DR. CHARLES JOSEPH SMUTNY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
717 LARKFIELD RD, COMMACK, NY 11725-2600
(631) 486-4720
(631) 486-4722
Mailing address
717 LARKFIELD RD, COMMACK, NY 11725-2600
(631) 486-4720
(631) 486-4722
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
206232
NY
171100000X
Acupuncturist
206232
NY
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
206232
NY
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
206232
NY
208D00000X
General Practice Physician
206232
NY
208VP0000X
Pain Medicine Physician
206232
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01V30EN311
MEDICARE INTERUM INDIVPIN
NY
01
—
1639358799
GROUP NPI
NY
01
—
1912962473
INDIVIDUAL NPI
NY
01
—
206232
NY STATE LICENSE #
NY
01
—
62296658
INDIVIDUAL MEDICARE PIN
NY
01
—
WEN311
MEDICARE GROUP PIN
NY
Enumeration date
04/19/2006
Last updated
09/04/2014
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