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General NPI Number Information
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NPI Number | 1821491192
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Entity Type | Organization
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Legal Business Name | SMITHVILLE PODIATRY & WOUND CARE LLC
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 29 SOUTH NEW YORK RD SUITE 800
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City | SMITHVILLE
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State | NJ
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Zip | 08205
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Country | US
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Telephone | 609-404-3200
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Fax | 609-404-4251
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Provider Business Mailing Address
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Address Line | 29 SOUTH NEW YORK RD SUITE 800
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City | SMITHVILLE
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State | NJ
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Zip | 08205
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Country | US
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Telephone | 609-404-3200
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Fax | 609-404-4251
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Authorized Official
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Title or Position | OWNER
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Name | MS. EMMA L. BRYAN
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Credential | DPM, CWS
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Telephone | 609-404-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | MD00252200
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License Number State | NJ
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