Provider Demographics
NPI:1902318934
Name:SMILEY, MARK (LAC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SMILEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CHURCH ST APT C
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1936
Mailing Address - Country:US
Mailing Address - Phone:201-825-4808
Mailing Address - Fax:
Practice Address - Street 1:161 N FRANKLIN TPKE STE 104
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1649
Practice Address - Country:US
Practice Address - Phone:201-825-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty