Provider Demographics
NPI:1699207662
Name:CARROLL, SMITA (MD, MBA, MPH)
Entity type:Individual
Prefix:
First Name:SMITA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:
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 1:331 NEWMAN SPRINGS RD
Mailing Address - Street 2:BLDG 2, STE 220
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:STE 607
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1962
Practice Address - Country:US
Practice Address - Phone:551-996-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321357-01207V00000X, 207VC0300X
NJ25MA12595900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family Planning