Provider Demographics
NPI:1699265132
Name:SMITH, ZACHARIAH G (APN)
Entity type:Individual
Prefix:MR
First Name:ZACHARIAH
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 712
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08362-0712
Mailing Address - Country:US
Mailing Address - Phone:856-693-5859
Mailing Address - Fax:
Practice Address - Street 1:499 BECKETT RD STE 201
Practice Address - Street 2:
Practice Address - City:LOGAN TWP
Practice Address - State:NJ
Practice Address - Zip Code:08085
Practice Address - Country:US
Practice Address - Phone:856-467-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00819300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily