Healthcare Provider Details

I. General information

NPI: 1295727576
Provider Name (Legal Business Name): SMITHVILLE MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 S NEW YORK RD SUITE C4
GALLOWAY NJ
08205-9695
US

IV. Provider business mailing address

28 SOUTH NEW YORK RD SUITE C 4
GALLOWAY NJ
08205-9753
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-0555
  • Fax: 609-652-1414
Mailing address:
  • Phone: 609-652-0555
  • Fax: 609-652-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAMCHARD THADHANI
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 609-652-0555