Basic Information
| Provider Information | |||||||||
| NPI: | 1730710781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | BODKIN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 ORCHARD PARK RD STE A105 | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142242654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166776000 | ||||||||
| FaxNumber: | 7166776006 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 ORCHARD PARK RD STE B103 | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142242655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166775005 | ||||||||
| FaxNumber: | 7167120160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2020 | ||||||||
| LastUpdateDate: | 03/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 716953 | NY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 345460 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.