MEDICARE: SMART CARE PEDIATRICS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	25MA085322100	NJ

General Provider Information

NPI Number	:	1033532205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART CARE PEDIATRICS PC

Provider Business Mailing Address
First Line	:	51 CONGRESSIONAL PKWY
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-2134
Country	:	US
Telephone Number	:	201-446-6701
Fax Number	:	201-875-5443

Provider Business Practice Location Address
First Line	:	1640 SCHLOSSER ST
Second Line	:	SUITE C-3
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5656
Country	:	US
Telephone Number	:	201-446-6701
Fax Number	:

Authorized Official
Title or Position	:	BILLER
Name	:	MR. BRIAN KIM
Credential	:
Telephone Number	:	201-446-6701

Provider Enumeration Date	:	01/24/2014
Last Update Date	:	01/24/2014

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