Basic Information
| Provider Information | |||||||||
| NPI: | 1275827420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMALL | ||||||||
| FirstName: | ADAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 1ST AVE # 9N | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465010647 | ||||||||
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| Practice Location | |||||||||
| Address1: | 530 1ST AVE # 9N | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465010647 | ||||||||
| FaxNumber: | 2122637908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2011 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD452108 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MT199303 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 303556 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 208000000X | MT199303 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207RA0002X | 303556 | NY | Y |
No ID Information.