Basic Information
| Provider Information | |||||||||
| NPI: | 1720013196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMICK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 HOLLY LANE | ||||||||
| Address2: | |||||||||
| City: | PILESGROVE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567694210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 HADDONFIELD RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080022604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566637690 | ||||||||
| FaxNumber: | 8566639269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 09/26/2016 | ||||||||
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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 | 207Q00000X | 25MB06566200 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7360207 | 05 | NJ | MEDICAID |