Provider Demographics
NPI:1790946812
Name:CHESTER R SMIALOWICZ MD LLC
Entity Type:Organization
Organization Name:CHESTER R SMIALOWICZ MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:609-677-1046
Mailing Address - Street 1:PO BOX 1283
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-6283
Mailing Address - Country:US
Mailing Address - Phone:609-677-1046
Mailing Address - Fax:609-677-1306
Practice Address - Street 1:200 TRENTON ROAD
Practice Address - Street 2:DEBORAH HEART AND LUNG CENTER
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015
Practice Address - Country:US
Practice Address - Phone:609-677-1046
Practice Address - Fax:609-677-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093635Medicare PIN