1295727576 NPI number — SMITHVILLE MEDICAL ASSOCIATES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295727576 NPI number — SMITHVILLE MEDICAL ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITHVILLE MEDICAL ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1295727576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 SOUTH NEW YORK RD
Provider Second Line Business Mailing Address:
SUITE C 4
Provider Business Mailing Address City Name:
GALLOWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08205-9753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-652-0555
Provider Business Mailing Address Fax Number:
609-652-1414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 S NEW YORK RD
Provider Second Line Business Practice Location Address:
SUITE C4
Provider Business Practice Location Address City Name:
GALLOWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08205-9695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-652-0555
Provider Business Practice Location Address Fax Number:
609-652-1414
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
THADHANI
Authorized Official First Name:
RAMCHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
609-652-0555

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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