MEDICARE: DR. MARIANNE CATHERINE SMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	179204	NY

General Provider Information

NPI Number	:	1477678688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANNE CATHERINE SMITH M.D.

Provider Business Mailing Address
First Line	:	1 KAREN TER
Second Line	:
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-1807
Country	:	US
Telephone Number	:	908-928-9132
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 SEAVIEW AVE
Second Line	:	ROOM301
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2216
Country	:	US
Telephone Number	:	718-226-6216
Fax Number	:	718-226-1528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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