1497831465 NPI number — MR. JASON D SMITH NP

Table of content: MR. JASON D SMITH NP (NPI 1497831465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497831465 NPI number — MR. JASON D SMITH NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
JASON
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497831465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3674 ROUTE 27, PRINCETON RADIOLOGY ASSOCIATES, P.A.
Provider Second Line Business Mailing Address:
DEPARTMENT B
Provider Business Mailing Address City Name:
KENDALL PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-821-5563
Provider Business Mailing Address Fax Number:
732-821-6675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3674 ROUTE 27, PRINCETON RADIOLOGY ASSOCIATES, P.A.
Provider Second Line Business Practice Location Address:
DEPARTMENT B
Provider Business Practice Location Address City Name:
KENDALL PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-821-5563
Provider Business Practice Location Address Fax Number:
732-821-6675
Provider Enumeration Date:
10/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  26NJ00070100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26NO11579400 . This is a "REGISTERED PROF NURSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 26NJ00070100 . This is a "ADVANCED PRACTICE NURSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".