Derrick Smith

Primary specialty

SpecialistTaxonomy code 174400000X

License

1526590211 Issued in NY

Practice address

530 Tinton Ave
Bronx, NY 10455-4516

Phone

(646) 231-1764

NPI assigned

Dec 17, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legendarii Smith LLC

  • Early Intervention Provider Agency
  • Bronx, NY
  • NPI 1003773490
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1184384117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 TINTON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104554516",
            "telephone_number": "646-231-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 TINTON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104554516",
            "telephone_number": "646-231-1764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DERRICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-17",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "1526590211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dajah Smith
• Darryl Curtis Smith, MD MPH
• Deborah Smith
• Deborah Anne Smith, CNM
• Denise D Smith
• Dionne Sophia Smith
• Donna Elaine Smith, RN
• Elsworth D Smith, PHARM.D.
• Erin Marie Smith
• Ernst Smith, MD

• Specialist in Bronx, NY
• Providers in Bronx, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.