MR. STACY DOUGLAS SMITH (NPI# 1912262148) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912262148 |
| Entity Type | Individual |
| Full Name | MR. STACY DOUGLAS SMITH |
| Credential | A.T.,C |
| Practice Address |
80 Johnson Ave Shabazz Newark NJ 07108 |
| Practice Telephone | 9737444113 |
| Mailing Telephone | 9737444113 |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2016-06-14 |
| NPI Deactivation Date | 08/10/2012 |
| NPI Reactivation Date | 2016-06-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
25MT00037500 | NJ | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306472428 | Stacy Renee Smith | Specialist/Technologist | 1708 Surrey Ct, Garland, TX 75043-1355 | 2020-03-20 |
| 1508338856 | Stacy Smith | Pediatrics | 5345 Fm 3 S, Marquez, TX 77865-4303 | 2018-12-27 |
| 1245612779 | Stacy G. Smith | Counselor | 24 Godwin Ave Ste 210, Midland Park, NJ 07432-1927 | 2015-06-21 |
| 1730583501 | Stacy Lynn Smith | Pharmacist | 1017 W Haul Rd, Page, AZ 86040-0656 | 2014-10-22 |
| 1881953214 | Stacy J Smith | Occupational Therapist | 10240 E Vicksburg St, Tucson, AZ 85748-3462 | 2012-05-04 |
| 1407139546 | Stacy Marie Smith | Registered Nurse | 1310 E 7th St., Ste J, Auburn, IN 46706 | 2011-09-26 |
| 1306138235 | Stacy Victoria Smith | Psychiatry & Neurology | 17183 Interstate 45 S Ste 690, Shenandoah, TX 77385-3317 | 2011-05-11 |
| 1871898858 | Stacy Smith | Counselor | 100 South Ridge Road, Suite 201 C, Breckenridge, CO 80424 | 2011-01-21 |
| 1740476514 | Stacy Ann Smith | Counselor | 4525 Draper Rd, Raleigh, NC 27616-5674 | 2007-09-14 |
| 1255532495 | Stacy M. Smith | Dietitian, Registered | 261 Parkway Dr Ne, Atlanta, GA 30312-1210 | 2007-05-29 |
| Street Address |
80 JOHNSON AVE SHABAZZ |
| City | NEWARK |
| State | NJ |
| Zip Code | 07108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710199468 | Jewish Renaissance Medical Center, Inc. | Clinic/Center | 80 Johnson Ave, Newark, NJ 07108-2729 | 2007-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376129 | Star Medcare PC | Physical Medicine & Rehabilitation | 62 Elizabeth Ave., Newark, NJ 07108 | 2020-11-02 |
| 1326665480 | Deandra Guzman | Counselor | 431-435 18th Avenue, Newark, NJ 07108 | 2020-07-06 |
| 1225579857 | Q and K Home Care Services Limited Liability Company | Community Health Worker | 191 Milford Avenue, Newark, NJ 07108 | 2017-03-15 |
| 1932646783 | Helping Hands Medical Supply | Durable Medical Equipment & Medical Supplies | 351-353 Avon Avenue, Rear Door, Newark, NJ 07108 | 2017-01-31 |
| 1366823619 | Community Action for Independent Living, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 504-506 Mt. Prospect Ave, Newark, NJ 07108 | 2015-06-12 |
| 1346650835 | Adeboye Adeoye Adeniran | Physical Therapy Assistant | 110 Somerset Street, Apt 3a, Newark, NJ 07108 | 2014-05-06 |
| 1952739435 | Unity Global Agency LLC | Home Health | 634 Clinton Avenue, 304, Newark, NJ 07108 | 2013-10-22 |
| 1598996704 | Best Interest Homecare | Chore Provider | 155 1/2d Avon Ave., Newark, NJ 07108 | 2009-08-05 |
| 1790840130 | Rose Garden Nutrition Inc | Pharmacy | 22 Elizabeth Ave, Suite 100, Newark, NJ 07108 | 2006-12-26 |
| 1053494187 | Colden Douglas Raines Jr. | Dentist | 603 Clinton Ave, Newark, NJ 07108 | 2006-10-23 |
| Find all providers in zip 07108 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235759143 | Melanie Lu | Specialist/Technologist | 123 Halloween Run, Newark, DE 19702-2312 | 2020-04-21 |
| 1245865310 | William James Gaffney | Specialist/Technologist | 541 S College Ave, Newark, DE 19716 | 2020-03-09 |
| 1700418431 | Tyler Dalton | Specialist/Technologist | 130 New London Rd, Newark, DE 19711-7037 | 2020-02-11 |
| 1528690260 | Laura Durkee | Specialist/Technologist | 329 E Main St Apt 310, Newark, DE 19711-7199 | 2020-02-11 |
| 1396377347 | Kyle Alea | Specialist/Technologist | 1365 Pulaski Hwy, Newark, DE 19702-5105 | 2020-02-07 |
| 1851923957 | Sabrina Bermudez | Specialist/Technologist | 240 Mount Vernon Pl Apt 7k, Newark, NJ 07106-3130 | 2020-02-06 |
| 1225674633 | Michael Francis Stant | Specialist/Technologist | Delaware Field House, 617 South College Avenue Rm 111b, Newark, DE 19713 | 2019-11-20 |
| 1730649658 | Neil Turner | Specialist/Technologist | 4051 Ogletown Rd Ste 202a, Newark, DE 19713-3101 | 2019-03-25 |
| 1053882779 | Emma Leigh Nelson | Specialist/Technologist | 16647 Townhouse Rd, Newark, IL 60541-9219 | 2018-12-06 |
| 1679042295 | Henry Paul Grayner | Specialist/Technologist | 100 Lock St, Newark, NJ 07102 | 2018-11-14 |
| Find all providers in NEWARK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.