MEDICARE: HASKELL TOWNE MEDICAL, LLC

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	25MB07737100	NJ

General Provider Information

NPI Number	:	1497948665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HASKELL TOWNE MEDICAL, LLC

Provider Business Mailing Address
First Line	:	1141 RINGWOOD AVE
Second Line	:	SUITE 7
City	:	HASKELL
State	:	NJ
Zip	:	07420-1565
Country	:	US
Telephone Number	:	973-835-6777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 RINGWOOD AVE
Second Line	:	SUITE 7
City	:	HASKELL
State	:	NJ
Zip	:	07420-1565
Country	:	US
Telephone Number	:	973-835-6777
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN, OWNER
Name	:	DR. JEFFREY TODD SMITH
Credential	:	D.O.
Telephone Number	:	973-835-6777

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	10/07/2015

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