Provider Demographics
NPI:1437212586
Name:DAVID J SMITH MD PA
Entity Type:Organization
Organization Name:DAVID J SMITH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-823-8488
Mailing Address - Street 1:4807 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08406
Mailing Address - Country:US
Mailing Address - Phone:609-823-8488
Mailing Address - Fax:609-823-1787
Practice Address - Street 1:4807 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR
Practice Address - State:NJ
Practice Address - Zip Code:08406
Practice Address - Country:US
Practice Address - Phone:609-823-8488
Practice Address - Fax:609-823-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02945300207W00000X
PAMD015011E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2696801Medicaid
D90475Medicare UPIN
NJ2696801Medicaid
NJ0738630001Medicare NSC