Provider Demographics
NPI:1962060111
Name:SMITH, ANNE-LOUISE
Entity type:Individual
Prefix:
First Name:ANNE-LOUISE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVE (PODIATRY DEPARTMENT)
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-624-8022
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVE (PODIATRY DEPARTMENT)
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-624-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2020-01-27
Deactivation Date:2020-01-17
Deactivation Code:
Reactivation Date:2020-01-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program