Provider Demographics
NPI:1730120940
Name:SMITH, JAMES M (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0060
Mailing Address - Fax:732-212-0061
Practice Address - Street 1:1904 ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1006
Practice Address - Country:US
Practice Address - Phone:732-528-1010
Practice Address - Fax:732-528-2139
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00665400225100000X
NY0150041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00332998OtherRR MEDICARE
NJ101444V2JMedicare PIN
NJP00332998OtherRR MEDICARE
NJ101444VFMMedicare PIN
NJ101444V2NMedicare PIN
NJ101444Medicare PIN
NJ119598XKSMedicare PIN