Provider Demographics
NPI:1477678688
Name:SMITH, MARIANNE CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:CATHERINE
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 1:1 KAREN TER
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1807
Mailing Address - Country:US
Mailing Address - Phone:908-928-9132
Mailing Address - Fax:
Practice Address - Street 1:360 SEAVIEW AVE
Practice Address - Street 2:ROOM301
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2216
Practice Address - Country:US
Practice Address - Phone:718-226-6216
Practice Address - Fax:718-226-1528
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine