Healthcare Provider Details

I. General information

NPI: 1467712976
Provider Name (Legal Business Name): DONNA M. SMITH, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 MILLBURN AVE SUITE 306
MAPLEWOOD NJ
07040-3726
US

IV. Provider business mailing address

2040 MILLBURN AVE SUITE 306
MAPLEWOOD NJ
07040-3726
US

V. Phone/Fax

Practice location:
  • Phone: 973-313-2600
  • Fax:
Mailing address:
  • Phone: 973-313-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONNA M. SMITH
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 973-313-2600