Healthcare Provider Details

I. General information

NPI: 1780597617
Provider Name (Legal Business Name): ABIGAIL SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W JIMMIE LEEDS RD
POMONA NJ
08240-9102
US

IV. Provider business mailing address

65 W JIMMIE LEEDS RD
POMONA NJ
08240-9102
US

V. Phone/Fax

Practice location:
  • Phone: 609-748-7510
  • Fax: 609-748-7511
Mailing address:
  • Phone: 609-748-7510
  • Fax: 609-748-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: