Provider Demographics
NPI:1871795724
Name:SMOLLER, HOWARD PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:PAUL
Last Name:SMOLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2720
Mailing Address - Country:US
Mailing Address - Phone:845-896-1400
Mailing Address - Fax:845-831-8507
Practice Address - Street 1:155 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2720
Practice Address - Country:US
Practice Address - Phone:845-896-1400
Practice Address - Fax:845-831-8507
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional