Healthcare Provider Details

I. General information

NPI: 1225326846
Provider Name (Legal Business Name): NICOLE RAE SMIZER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2011
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE RD
NEW HYDE PARK NY
11042-1101
US

IV. Provider business mailing address

410 LAKEVILLE RD
NEW HYDE PARK NY
11042-1101
US

V. Phone/Fax

Practice location:
  • Phone: 516-437-4300
  • Fax: 516-437-2033
Mailing address:
  • Phone: 516-437-4300
  • Fax: 516-437-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number78111537
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: