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NPI Code Detail

MEDICARE: DR. JONATHAN K. SMITH M. D.

MEDICARE: DR. JONATHAN K. SMITH M. D.
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
1208600000XSurgery PhysicianME152013FL
2208600000XSurgery Physician25MA10538700NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255394177
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN K. SMITH M. D.
Provider Business Mailing Address
First Line : 379 CAMPUS DR FL 4
Second Line :
City : SOMERSET
State : NJ
Zip : 08873-1161
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 195 LITTLE ALBANY ST
Second Line :
City : NEW BRUNSWICK
State : NJ
Zip : 08901-1914
Country : US
Telephone Number : 732-235-2465
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 10/16/2024

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