Charles Joseph Smutny III, D.O.

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

206232 Issued in NY

Practice address

717 Larkfield Rd
Commack, NY 11725-2600

Phone

(631) 486-4720

Fax

(631) 486-4722

NPI assigned

Apr 19, 2006

Reactivated

Sep 4, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

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

• Access Osteopathy PC

  • Neuromusculoskeletal Medicine & OMM Physician
  • Commack, NY
  • NPI 1639358799
  Authorized official Same address or phone

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409788800000",
    "number": "1912962473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 LARKFIELD RD",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252600",
            "telephone_number": "631-486-4720",
            "fax_number": "631-486-4722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 LARKFIELD RD",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252600",
            "telephone_number": "631-486-4720",
            "fax_number": "631-486-4722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMUTNY",
        "first_name": "CHARLES",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2014-09-04",
        "deactivation_date": "2011-02-22",
        "reactivation_date": "2014-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "NY",
            "license": "206232",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "206232",
            "primary": false
        },
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "NY",
            "license": "206232",
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "NY",
            "license": "206232",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "206232",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NY",
            "license": "206232",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1912962473",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PIN",
            "identifier": "WEN311",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INTERUM INDIVPIN",
            "identifier": "01V30EN311",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1639358799",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE LICENSE #",
            "identifier": "206232",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "01V30EN311",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL MEDICARE PIN",
            "identifier": "62296658",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janet M. Sloboda, PTA
• Lynn Goldberg Smith, MSCCCSLP
• Margaret Smith
• Megan Smith
• Victoria G. Smith, M.S.
• Joann So Ryerson, OTR/L
• Jennifer K Sohn, M.D.
• Karen A. Solomon, LCSW
• Solutions Counseling LCSW PLLC
• Rachna Sharma Sondhi, M.D.

• Neuromusculoskeletal Medicine & OMM Physician in Commack, NY
• Providers in Commack, NY by specialty
• Neuromusculoskeletal Medicine & OMM Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; 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.