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General NPI Number Information
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NPI Number | 1891706453
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Entity Type | Individual
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Provider Name | DONALD FRANK SMITH JR. ATC
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 462 MILLBURN AVE
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City | MILLBURN
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State | NJ
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Zip | 07042
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Country | US
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Telephone | 973-376-3600
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Fax | 973-912-8633
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Provider Business Mailing Address
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Address Line | 402 PACIFIC ST
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City | PATERSON
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State | NJ
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Zip | 07503-1919
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Country | US
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Telephone | 973-715-0247
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Fax | 973-912-8633
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00035700
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License Number State | NJ
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