Basic Information
| Provider Information | |||||||||
| NPI: | 1336187657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221-26 112TH AVENUE | ||||||||
| Address2: | QUEENS VILLAGE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114292509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182195001 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 170 WILLIAM STREET | ||||||||
| Address2: | NEW YORK UNIVERSITY DOWNTOWN HOSPITAL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123125068 | ||||||||
| FaxNumber: | 2123125985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 11/12/2007 | ||||||||
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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 | 207P00000X | 212407 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | ME0071070 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31665 | 01 | FL | BCBS | OTHER |