1700849296 NPI number — CLIVE N SMITH MD

Table of content: CLIVE N SMITH MD (NPI 1700849296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700849296 NPI number — CLIVE N SMITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CLIVE
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1700849296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
279 3RD AVE
Provider Second Line Business Mailing Address:
SUITE 502
Provider Business Mailing Address City Name:
LONG BRANCH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07740-6205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-222-8865
Provider Business Mailing Address Fax Number:
732-222-8312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
279 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 502
Provider Business Practice Location Address City Name:
LONG BRANCH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07740-6205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-222-8865
Provider Business Practice Location Address Fax Number:
732-222-8312
Provider Enumeration Date:
04/07/2006

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: 207R00000X , with the licence number:  MA021939 , 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: 0004234549 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P55428738 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: F13498 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P675693 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0090195000 . This is a "AMERI HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2721309 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com