Provider Demographics
NPI:1699207662
Name:CARROLL, SMITA (MD, MBA, MPH)
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MD, MBA, MPH
Other - Prefix:
Other - First Name:SMITA
Other - Middle Name:
Other - Last Name:RAVICHANDRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:18 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2014
Mailing Address - Country:US
Mailing Address - Phone:845-300-6073
Mailing Address - Fax:
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1850
Practice Address - Country:US
Practice Address - Phone:212-434-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321357-01207VC0300X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family Planning
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology