Provider Demographics
NPI:1922832674
Name:CHRYSA SMALLEY ANP INC.
Entity type:Organization
Organization Name:CHRYSA SMALLEY ANP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-322-9724
Mailing Address - Street 1:15 WOODLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754
Mailing Address - Country:US
Mailing Address - Phone:516-322-9724
Mailing Address - Fax:
Practice Address - Street 1:121 PULASKI RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2539
Practice Address - Country:US
Practice Address - Phone:516-322-9724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty