Provider Demographics
NPI:1588683098
Name:SMOTRICH, GARY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:SMOTRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BLDG 5
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-896-2525
Mailing Address - Fax:609-896-2639
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BLDG 5
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-896-2525
Practice Address - Fax:609-896-2639
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05344900208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ476133TUZMedicare PIN