Provider Demographics
NPI:1427094259
Name:SMITH, MAASI JACOB (DPM)
Entity type:Individual
Prefix:DR
First Name:MAASI
Middle Name:JACOB
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-2579
Mailing Address - Country:US
Mailing Address - Phone:215-665-9225
Mailing Address - Fax:215-665-9242
Practice Address - Street 1:25 BALA AVE STE 105
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3214
Practice Address - Country:US
Practice Address - Phone:215-665-9225
Practice Address - Fax:215-665-9242
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004747-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01892600Medicaid
PA070572 / 055061RUJMedicare ID - Type Unspecified
PA01892600Medicaid