MEDICARE: ELIZABETH ANN SMOLSKY MSN, APN, C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	26NJ00026000	NJ
2	363LF0000X	Family Nurse Practitioner	26NJ00026000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235118555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN SMOLSKY MSN, APN, C

Provider Business Mailing Address
First Line	:	103 OLD MARLTON PIKE
Second Line	:	SUITE 111
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8772
Country	:	US
Telephone Number	:	609-953-7111
Fax Number	:	609-953-1544

Provider Business Practice Location Address
First Line	:	103 OLD MARLTON PIKE
Second Line	:	SUITE 111
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8772
Country	:	US
Telephone Number	:	609-953-7111
Fax Number	:	609-953-1544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	12/23/2016

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