Provider Demographics
NPI:1205004181
Name:SMB MEDICAL, PC
Entity Type:Organization
Organization Name:SMB MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-271-3548
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:718-271-3548
Mailing Address - Fax:718-606-0719
Practice Address - Street 1:9522 63RD RD
Practice Address - Street 2:531
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1142
Practice Address - Country:US
Practice Address - Phone:718-271-3548
Practice Address - Fax:718-606-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231488208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY231488OtherLICENSE