Healthcare Provider Details

I. General information

NPI: 1275908972
Provider Name (Legal Business Name): JAMES W. SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 COMPTON ST
BELFORD NJ
07718-1508
US

IV. Provider business mailing address

40 COMPTON STREET
BELFORD NJ
07718
US

V. Phone/Fax

Practice location:
  • Phone: 732-708-1661
  • Fax:
Mailing address:
  • Phone: 732-708-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: