Provider Demographics
NPI:1831332998
Name:SMITS, GLENN J (LAC)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:J
Last Name:SMITS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 ROUTE 299
Mailing Address - Street 2:STE 3
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-7515
Mailing Address - Country:US
Mailing Address - Phone:914-799-1446
Mailing Address - Fax:845-647-8455
Practice Address - Street 1:216 ROUTE 299
Practice Address - Street 2:STE 3
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-7515
Practice Address - Country:US
Practice Address - Phone:914-799-1446
Practice Address - Fax:845-647-8455
Is Sole Proprietor?:No
Enumeration Date:2009-04-19
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001414171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist