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General NPI Number Information
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NPI Number | 1780890814
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Entity Type | Organization
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Legal Business Name | LEON G. SMITH JR. MD, LLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 155 JEFFERSON ST
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City | NEWARK
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State | NJ
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Zip | 07105-1706
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Country | US
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Telephone | 973-403-1922
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Fax | 973-403-1912
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Provider Business Mailing Address
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Address Line | 171 OLD CHESTER RD
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City | ESSEX FELLS
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State | NJ
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Zip | 07021-1624
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Country | US
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Telephone | 973-403-1922
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Fax |
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | LEON SMITH JR.
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Credential | MD
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Telephone | 973-403-1922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA05307800
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License Number State | NJ
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