Provider Demographics
NPI:1003857467
Name:SMIALOWICZ, CHESTER R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:R
Last Name:SMIALOWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1283
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-6283
Mailing Address - Country:US
Mailing Address - Phone:609-677-1046
Mailing Address - Fax:609-677-1306
Practice Address - Street 1:200 TRENTON RD
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-1705
Practice Address - Country:US
Practice Address - Phone:609-677-1046
Practice Address - Fax:609-677-1306
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA02594500207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ162339Medicare PIN