Individual
JOHN P SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1501 BROADWAY, SUITE 4, FAIRLAWN, NJ 07410
(201) 794-6505
(201) 794-1167
Mailing address
1501 BROADWAY, SUITE 4, FAIRLAWN, NJ 07410
(201) 794-6505
(201) 794-1167
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
029040
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0465607
—
NJ
Enumeration date
11/07/2006
Last updated
07/01/2010
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