Provider Demographics
NPI:1144638248
Name:SMITH, BRIDGET ROSE (OTR)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 QUINBY AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3118
Mailing Address - Country:US
Mailing Address - Phone:201-406-0293
Mailing Address - Fax:
Practice Address - Street 1:80 QUINBY AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-3118
Practice Address - Country:US
Practice Address - Phone:201-406-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00495600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist