Provider Demographics
NPI:1720013196
Name:SMICK, ROBERT JAY (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
Last Name:SMICK
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 1:56 HOLLY LANE
Mailing Address - Street 2:
Mailing Address - City:PILESGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08098
Mailing Address - Country:US
Mailing Address - Phone:856-769-4210
Mailing Address - Fax:
Practice Address - Street 1:211 BENIGNO BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BELLMAWR
Practice Address - State:NJ
Practice Address - Zip Code:08031-2513
Practice Address - Country:US
Practice Address - Phone:856-931-0691
Practice Address - Fax:856-931-9253
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008685L207Q00000X
NJ25MB06566200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7360207Medicaid
NJ821972Medicare ID - Type Unspecified
NJ7360207Medicaid