Provider Demographics
NPI:1104666346
Name:SMITH, CARL M JR
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:M
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-6107
Mailing Address - Country:US
Mailing Address - Phone:856-745-3453
Mailing Address - Fax:
Practice Address - Street 1:98 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:PINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:08021-6107
Practice Address - Country:US
Practice Address - Phone:856-745-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide