Healthcare Provider Details

I. General information

NPI: 1902719958
Provider Name (Legal Business Name): AHMAD RASHAD SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266-272 CHESTNUT ST
NEWARK NJ
07105-6521
US

IV. Provider business mailing address

515 ELIZABETH AVE APT 13K
NEWARK NJ
07112-2549
US

V. Phone/Fax

Practice location:
  • Phone: 973-494-7469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02452000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: