Provider Demographics
NPI:1467454751
Name:SMITH, LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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 51027
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-5127
Mailing Address - Country:US
Mailing Address - Phone:973-322-5287
Mailing Address - Fax:973-322-2309
Practice Address - Street 1:94 OLD SHORT HILLS RD
Practice Address - Street 2:STE 402
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5672
Practice Address - Country:US
Practice Address - Phone:973-322-5287
Practice Address - Fax:973-322-2309
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05307800207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJES274OtherOXFORD ID #
NJ160059398OtherRAILROAD MEDICARE
NJ0535026000OtherAMERIHEALTH
NJ2K2133OtherHEALTHNET ID #
NJ4992601Medicaid
NJ576E61OtherEMPIRE BC/BS OF NY ID #
NJC67646Medicare UPIN
NJ699749RJQMedicare PIN