Healthcare Provider Details

I. General information

NPI: 1467454751
Provider Name (Legal Business Name): LEON SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD STE 402
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

PO BOX 51027
NEWARK NJ
07101-5127
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-5287
  • Fax: 973-322-2309
Mailing address:
  • Phone: 973-322-5287
  • Fax: 973-322-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number25MA05307800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: