1790946812 NPI number — CHESTER R SMIALOWICZ MD 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 1790946812 NPI number — CHESTER R SMIALOWICZ MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTER R SMIALOWICZ MD 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:
1790946812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1283
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08055-6283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-677-1046
Provider Business Mailing Address Fax Number:
609-677-1306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 TRENTON ROAD
Provider Second Line Business Practice Location Address:
DEBORAH HEART AND LUNG CENTER
Provider Business Practice Location Address City Name:
BROWNS MILLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-677-1046
Provider Business Practice Location Address Fax Number:
609-677-1306
Provider Enumeration Date:
06/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
609-677-1046

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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