Provider Demographics
NPI:1609817899
Name:SCANLON-SMITH, ANN (APN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:SCANLON-SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 MAIN ST
Mailing Address - Street 2:ST. JOSEPH'S REGIONAL MEDICAL CENTER
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2621
Mailing Address - Country:US
Mailing Address - Phone:973-754-2052
Mailing Address - Fax:
Practice Address - Street 1:160 MARKET ST
Practice Address - Street 2:COMPREHENSIVE CARE CENTER
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1702
Practice Address - Country:US
Practice Address - Phone:973-754-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06138400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ65333Medicare UPIN
NJ099005Medicare ID - Type Unspecified