Provider Demographics
NPI:1538779343
Name:SMITH, MOLLY (NP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W 60TH ST APT 20F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7945
Mailing Address - Country:US
Mailing Address - Phone:914-673-7689
Mailing Address - Fax:
Practice Address - Street 1:161 FORT WASHINGTON
Practice Address - Street 2:HERBERT IRVING PAVILION
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1003
Practice Address - Country:US
Practice Address - Phone:914-673-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309781363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty