Provider Demographics
NPI:1659366904
Name:SMITH, JEFFREY TODD (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TODD
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 RINGWOOD AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HASKELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07420-1565
Mailing Address - Country:US
Mailing Address - Phone:201-424-7956
Mailing Address - Fax:
Practice Address - Street 1:1141 RINGWOOD AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:HASKELL
Practice Address - State:NJ
Practice Address - Zip Code:07420-1565
Practice Address - Country:US
Practice Address - Phone:973-835-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07737100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093293Medicare ID - Type UnspecifiedPROVIDER ID NUMBER
NJI36868Medicare UPIN