Individual
STACEY DIANE ELKHATIB SMIDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
65 JAMES STREET, NEUROSCIENCE INSTITUTE, EDISON, NJ 08820-3947
(732) 321-7010
Mailing address
65 JAMES ST, EDISON, NJ 08820-3947
(732) 321-7010
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
25MA10985100
NJ
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
Primary
25MA10985100
NJ
Other
Enumeration date
03/29/2013
Last updated
11/12/2021
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