Basic Information
| Provider Information | |||||||||
| NPI: | 1114987625 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMALLING | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 FOOTE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147016947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163389200 | ||||||||
| FaxNumber: | 7163389250 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 FOOTE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147016947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163389200 | ||||||||
| FaxNumber: | 7163389250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 05/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 009394 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 208800000X | 009394 | NY | N | Allopathic & Osteopathic Physicians | Urology | 363A00000X | 009394 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363LF0000X | 009394 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 117209FZ | 01 | PREFERRED CARE | OTHER | 9512418 | 01 | INDEPENDENT HEALTH | OTHER | P019009394 | 01 | BLUE CHOICE | OTHER | 000570446003 | 01 | COMMUNITY BLUE | OTHER | 02504727 | 05 | NY | MEDICAID | P00387380 | 01 | NY | RAILROAD MEDICARE | OTHER | 00026702202 | 01 | UNIVERA | OTHER |