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Individual

JOHANNA M SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
410 HALLOCK AVE, PORT JEFFERSON STATION, NY 11776-1232
(631) 642-1100
(631) 642-1190
Mailing address
2800 MARCUS AVE, NEW HYDE PARK, NY 11042-1113
(516) 622-6040

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
306296
NY

Other

Enumeration date
02/25/2013
Last updated
02/25/2013
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