Healthcare Provider Details

I. General information

NPI: 1568625028
Provider Name (Legal Business Name): HERBERT STEPHEN SMYCZEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2008
Last Update Date: 07/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 GROVE AVE
EDISON NJ
08820-3225
US

IV. Provider business mailing address

668 GROVE AVE
EDISON NJ
08820-3225
US

V. Phone/Fax

Practice location:
  • Phone: 732-548-5432
  • Fax:
Mailing address:
  • Phone: 732-548-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMA50528
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: