Provider Demographics
NPI:1245003375
Name:SMITH, MADISON (ATS)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 HACKENSACK PLANK RD APT 501
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-5924
Mailing Address - Country:US
Mailing Address - Phone:603-520-4401
Mailing Address - Fax:
Practice Address - Street 1:123 METRO BLVD
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-6101
Practice Address - Country:US
Practice Address - Phone:603-520-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer