Provider Demographics
NPI:1811056039
Name:SMITH, ENID DIANNE (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:ENID
Middle Name:DIANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W NORTHFIELD RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3789
Mailing Address - Country:US
Mailing Address - Phone:862-812-4300
Mailing Address - Fax:973-994-0828
Practice Address - Street 1:2 W NORTHFIELD RD
Practice Address - Street 2:SUITE 303
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3789
Practice Address - Country:US
Practice Address - Phone:862-812-4300
Practice Address - Fax:973-994-0828
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00068000231H00000X
NJ25MG00106800237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ620416Medicare ID - Type Unspecified