Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 26NJ01097600 | NJ |
NPI | 1013590876 |
---|---|
Provider Name | Nicole Elizabeth Smith |
First Address | Marlboro, NJ 07746-1089 |
Second Address | Marlboro, NJ 07746-1089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2021 |
Last Update Date | 29/04/2021 |