Provider Demographics
NPI:1417043894
Name:SMITH, TERRI L (MD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 EAST MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628
Mailing Address - Country:US
Mailing Address - Phone:201-244-1580
Mailing Address - Fax:201-244-1586
Practice Address - Street 1:307 EAST MADISON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628
Practice Address - Country:US
Practice Address - Phone:201-244-1580
Practice Address - Fax:201-244-1586
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059166208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics