MEDICARE: STACEY L SMICK PA

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	363A00000X	Physician Assistant	25MP00066000	NJ

General Provider Information

NPI Number	:	1538160015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY L SMICK PA

Provider Business Mailing Address
First Line	:	51 BUCKHORN RD
Second Line	:
City	:	SALEM
State	:	NJ
Zip	:	08079-9302
Country	:	US
Telephone Number	:	856-455-6770
Fax Number	:	856-455-6030

Provider Business Practice Location Address
First Line	:	70 CORNWELL DR
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-3602
Country	:	US
Telephone Number	:	856-455-6770
Fax Number	:	856-455-6030

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/12/2020

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Directions to “ STACEY L SMICK PA” Practice Location

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