Provider Demographics
NPI: | 1700333655 |
---|---|
Name: | JSMITH MD PC |
Entity Type: | Organization |
Organization Name: | JSMITH MD PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CHARLES |
Authorized Official - Middle Name: | G |
Authorized Official - Last Name: | HADDAD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 973-779-7979 |
Mailing Address - Street 1: | 1033 ROUTE 46 STE 102 |
Mailing Address - Street 2: | |
Mailing Address - City: | CLIFTON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07013-2448 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 973-779-7979 |
Mailing Address - Fax: | 973-779-7970 |
Practice Address - Street 1: | 1033 ROUTE 46 STE 102 |
Practice Address - Street 2: | |
Practice Address - City: | CLIFTON |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07013-2448 |
Practice Address - Country: | US |
Practice Address - Phone: | 973-779-7979 |
Practice Address - Fax: | 973-779-7970 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-09-08 |
Last Update Date: | 2016-09-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 25MA09182300 | 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Single Specialty |