Provider Demographics
NPI:1528327376
Name:SMIESKA, JOHN T III (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:SMIESKA
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W SENECA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3342
Mailing Address - Country:US
Mailing Address - Phone:607-273-7000
Mailing Address - Fax:607-273-7001
Practice Address - Street 1:1001 W SENECA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3342
Practice Address - Country:US
Practice Address - Phone:607-273-7000
Practice Address - Fax:607-273-7001
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant