Healthcare Provider Details

I. General information

NPI: 1740361377
Provider Name (Legal Business Name): KAREN VICTORIA SMREK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN VICTORIA GARLAND-SMREK NP

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK UNIVERSITY MEDICAL CTR T-19,HSC,ROOM 080
STONY BROOK NY
11794
US

IV. Provider business mailing address

205 GLENWOOD LN
PORT JEFFERSON NY
11777-1506
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1820
  • Fax: 631-444-8963
Mailing address:
  • Phone: 631-476-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number302950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: