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Individual

PETER SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
208 ROANOKE AVE, RIVERHEAD, NY 11901-2706
(631) 369-0104
Mailing address
208 ROANOKE AVE, RIVERHEAD, NY 11901-2706
(631) 369-0104

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401875
NY

Other

Enumeration date
07/02/2015
Last updated
04/06/2016
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