Provider Demographics
NPI:1326009382
Name:SMITH, DANIEL H (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 TEANECK ROAD
Mailing Address - Street 2:HOLY NAME MEDICAL CENTER, REGIONAL CANCER CENTER
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-0000
Mailing Address - Country:US
Mailing Address - Phone:201-227-6065
Mailing Address - Fax:201-227-6295
Practice Address - Street 1:718 TEANECK ROAD
Practice Address - Street 2:HOLY NAME MEDICAL CENTER, REGIONAL CANCER CENTER
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-0000
Practice Address - Country:US
Practice Address - Phone:201-227-6065
Practice Address - Fax:201-227-6295
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57701207VX0201X
NJ25MA05770100207VX0201X
NY146038207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3822303Medicaid
C10699Medicare UPIN
NJ3822303Medicaid