Provider Demographics
NPI:1700849296
Name:SMITH, CLIVE N (MD)
Entity Type:Individual
Prefix:
First Name:CLIVE
Middle Name:N
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 1:279 3RD AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6205
Mailing Address - Country:US
Mailing Address - Phone:732-222-8865
Mailing Address - Fax:732-222-8312
Practice Address - Street 1:279 3RD AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6205
Practice Address - Country:US
Practice Address - Phone:732-222-8865
Practice Address - Fax:732-222-8312
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA021939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004234549OtherAETNA
P55428738OtherMULTIPLAN
F13498OtherHEALTH NET
P675693OtherOXFORD
0090195000OtherAMERI HEALTH
NJ2721309Medicaid
P675693OtherOXFORD