Provider Demographics
NPI:1255394177
Name:SMITH, JONATHAN K (M D)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:K
Last Name:SMITH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 CAMPUS DR FL 4
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:195 LITTLE ALBANY ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1914
Practice Address - Country:US
Practice Address - Phone:732-235-2465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152013208600000X
NJ25MA10538700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
051049680OtherBCBS OF AL
AL113552Medicaid
AL130052Medicaid
51118230OtherBLUE CROSS/BLUE SHIELD OF ALABAMA
AL102I021331Medicare PIN
51118230OtherBLUE CROSS/BLUE SHIELD OF ALABAMA
KYVAD000Medicare UPIN