Individual provider Active NPI

Fergal Patrick Smyth

  • Registered Nurse
  • Bay Shore, NY
National Provider Identifier
1477046993
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
567001 Issued in NY
Practice address
67 West LN
Bay Shore, NY 11706-8622
Phone
(631) 665-6537
NPI assigned
Jun 9, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 567001 NY Primary

Addresses

Primary practice location

67 West LN
Bay Shore, NY 11706-8622

Mailing address

67 West LN
Bay Shore, NY 11706-8622
Phone (631) 665-6537

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
567001NYMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1528502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1477046993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 WEST LN",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068622",
            "telephone_number": "631-665-6537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 WEST LN",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068622",
            "telephone_number": "631-665-6537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMYTH",
        "first_name": "FERGAL",
        "middle_name": "PATRICK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-09",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "567001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.