Provider Demographics
NPI:1528286556
Name:J. MICHAEL SMITH, M.D., PA
Entity type:Organization
Organization Name:J. MICHAEL SMITH, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-895-0770
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BLDG 5
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-895-0770
Mailing Address - Fax:609-896-1124
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BLDG 5
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-895-0770
Practice Address - Fax:609-896-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K4080OtherHEALTHNET
NJ564146OtherAETNA
NJMEP119OtherOXFORD
NJ142249OtherPA BLUE SHIELD
NJ0716549001OtherAMERIHEALTH
NJMEP119OtherOXFORD
NJ142249OtherPA BLUE SHIELD