Provider Demographics
NPI:1477560910
Name:SMITH, JOHN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:113 MAPLE STREAM RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2409
Mailing Address - Country:US
Mailing Address - Phone:609-448-1292
Mailing Address - Fax:609-448-3507
Practice Address - Street 1:113 MAPLE STREAM RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2409
Practice Address - Country:US
Practice Address - Phone:609-448-1292
Practice Address - Fax:609-448-3507
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00135000213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45262Medicare UPIN
NJ452339ACDMedicare ID - Type UnspecifiedMEDICARE ID NUMBER