Provider Demographics
NPI:1063757284
Name:SMITH, STEVEN ANDREW (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2103
Mailing Address - Country:US
Mailing Address - Phone:718-986-2635
Mailing Address - Fax:
Practice Address - Street 1:40 MOORE RD
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2103
Practice Address - Country:US
Practice Address - Phone:718-986-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22681000163W00000X
NY653735163W00000X
NJ26NJ01244500363LF0000X
NY347221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ01244500OtherNJ APN LICENSE
NY347221OtherNYS LICENSE