Healthcare Provider Details

I. General information

NPI: 1699935098
Provider Name (Legal Business Name): LIAM R SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PLAINSBORO RD SUITE 400
PLAINSBORO NJ
08536-1915
US

IV. Provider business mailing address

5 PLAINSBORO RD SUITE 400
PLAINSBORO NJ
08536-1915
US

V. Phone/Fax

Practice location:
  • Phone: 609-936-9100
  • Fax: 609-936-9200
Mailing address:
  • Phone: 609-936-9100
  • Fax: 609-936-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA09337200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number25MA09337200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: