MEDICARE: MOLLY SMITH NP

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	363LA2200X	Adult Health Nurse Practitioner	309781	NY
2	363LG0600X	Gerontology Nurse Practitioner	309781	NY

General Provider Information

NPI Number	:	1538779343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY SMITH NP

Provider Business Mailing Address
First Line	:	45 W 60TH ST APT 20F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-7945
Country	:	US
Telephone Number	:	914-673-7689
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 FORT WASHINGTON
Second Line	:	HERBERT IRVING PAVILION
City	:	NEW YORK
State	:	NY
Zip	:	10032-1003
Country	:	US
Telephone Number	:	914-673-7689
Fax Number	:

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

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	04/27/2021

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