1275521361 NPI number — DR. JOHN E SMITH JR. M.D.

Table of content: DR. JOHN E SMITH JR. M.D. (NPI 1275521361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275521361 NPI number — DR. JOHN E SMITH JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
JOHN
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
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:
1275521361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 BRASS CASTLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08865-4327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-454-0370
Provider Business Mailing Address Fax Number:
908-454-9858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 MEMORIAL PARKWAY SUITE 102
Provider Second Line Business Practice Location Address:
HILLCREST PROFESSIONAL PLAZA
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08865-2774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-454-0370
Provider Business Practice Location Address Fax Number:
908-454-9858
Provider Enumeration Date:
10/12/2005

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: 207RH0003X , with the licence number:  MA073316 , 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: 1406833 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222144152 . This is a "INTERGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1406833 . This is a "INDEPENCENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100340 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8828105 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 222144152 . This is a "DEVON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1167146 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2807974 . This is a "AETNA PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1406833 . This is a "HIGHMARK BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2094464000 . This is a "KEYSTONE HEALTHPLAN EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222144152 . This is a "MAGNACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222144152 . This is a "HEALTHCRE PAYOR COALITION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9922910-003 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222144152 . This is a "HORIZON BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1406833 . This is a "PREMIERE BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50001283 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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