Basic Information
| Provider Information | |||||||||
| NPI: | 1528286556 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J. MICHAEL SMITH, M.D., PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 PRINCETON PIKE | ||||||||
| Address2: | BLDG 5 | ||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098950770 | ||||||||
| FaxNumber: | 6098961124 | ||||||||
| Practice Location | |||||||||
| Address1: | 3131 PRINCETON PIKE | ||||||||
| Address2: | BLDG 5 | ||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098950770 | ||||||||
| FaxNumber: | 6098961124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | J | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6098950770 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1K4080 | 01 | NJ | HEALTHNET | OTHER | 564146 | 01 | NJ | AETNA | OTHER | MEP119 | 01 | NJ | OXFORD | OTHER | 142249 | 01 | NJ | PA BLUE SHIELD | OTHER | 0716549001 | 01 | NJ | AMERIHEALTH | OTHER |