Provider Demographics
NPI:1821491192
Name:SMITHVILLE PODIATRY & WOUND CARE LLC
Entity Type:Organization
Organization Name:SMITHVILLE PODIATRY & WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, CWS
Authorized Official - Phone:609-404-3200
Mailing Address - Street 1:29 SOUTH NEW YORK RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SMITHVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08205
Mailing Address - Country:US
Mailing Address - Phone:609-404-3200
Mailing Address - Fax:609-404-4251
Practice Address - Street 1:29 SOUTH NEW YORK RD
Practice Address - Street 2:SUITE 800
Practice Address - City:SMITHVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08205
Practice Address - Country:US
Practice Address - Phone:609-404-3200
Practice Address - Fax:609-404-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD00252200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty