MEDICARE: DR. JEFFREY TODD SMITH DO

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	207R00000X	Internal Medicine Physician	25MB07737100	NJ

General Provider Information

NPI Number	:	1659366904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY TODD SMITH DO

Provider Business Mailing Address
First Line	:	1141 RINGWOOD AVE
Second Line	:	SUITE 7
City	:	HASKELL
State	:	NJ
Zip	:	07420-1565
Country	:	US
Telephone Number	:	201-424-7956
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 RINGWOOD AVE
Second Line	:	SUITE 7
City	:	HASKELL
State	:	NJ
Zip	:	07420-1565
Country	:	US
Telephone Number	:	973-835-6777
Fax Number	:

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	10/02/2015

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