Provider Demographics
NPI:1073862397
Name:SMB MEDICAL, P.C.
Entity Type:Organization
Organization Name:SMB MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MIRIAM
Authorized Official - Last Name:BAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-760-2800
Mailing Address - Street 1:9522 63RD RD
Mailing Address - Street 2:#531
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5901 94TH ST
Practice Address - Street 2:STE. E10
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5049
Practice Address - Country:US
Practice Address - Phone:718-271-3548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231488261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center