Basic Information
| Provider Information | |||||||||
| NPI: | 1275521361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 BRASS CASTLE RD | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088654327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084540370 | ||||||||
| FaxNumber: | 9084549858 | ||||||||
| Practice Location | |||||||||
| Address1: | 755 MEMORIAL PARKWAY SUITE 102 | ||||||||
| Address2: | HILLCREST PROFESSIONAL PLAZA | ||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088652774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084540370 | ||||||||
| FaxNumber: | 9084549858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 02/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MA073316 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1406833 | 01 | AMERIHEALTH | OTHER | 222144152 | 01 | INTERGROUP | OTHER | 1406833 | 01 | INDEPENCENCE BLUE CROSS | OTHER | 7100340 | 01 | AETNA PPO | OTHER | 8828105 | 05 | NJ | MEDICAID | 222144152 | 01 | DEVON | OTHER | 1167146 | 01 | HORIZON NJ HEALTH | OTHER | 2807974 | 01 | AETNA PROVIDER NUMBER | OTHER | 1406833 | 01 | HIGHMARK BLUE CROSS | OTHER | 2094464000 | 01 | KEYSTONE HEALTHPLAN EAST | OTHER | 222144152 | 01 | MAGNACARE | OTHER | 222144152 | 01 | HEALTHCRE PAYOR COALITION | OTHER | 9922910-003 | 01 | CIGNA HEALTHCARE | OTHER | 222144152 | 01 | HORIZON BLUE CROSS | OTHER | 1406833 | 01 | PREMIERE BLUE | OTHER | 50001283 | 01 | CAPITAL BLUE CROSS | OTHER |