Provider Demographics
NPI:1043494800
Name:SMITH, CLARK CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:CHARLES
Last Name:SMITH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:180 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 199
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3722
Mailing Address - Country:US
Mailing Address - Phone:212-305-3535
Mailing Address - Fax:212-342-1470
Practice Address - Street 1:180 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 199
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-305-3535
Practice Address - Fax:212-342-1470
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2014-07-24
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Provider Licenses
StateLicense IDTaxonomies
NY260227208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXVTR1Medicare PIN