Healthcare Provider Details

I. General information

NPI: 1063776474
Provider Name (Legal Business Name): BETH I SMUCKLER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 VIRGINIA AVE
PLAINVIEW NY
11803-3518
US

IV. Provider business mailing address

57 VIRGINIA AVE
PLAINVIEW NY
11803-3518
US

V. Phone/Fax

Practice location:
  • Phone: 516-443-2416
  • Fax:
Mailing address:
  • Phone: 516-443-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: