Provider Demographics
NPI:1144675000
Name:SMITH, GERARD
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 S COLLEGE AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-1302
Mailing Address - Country:US
Mailing Address - Phone:302-831-8893
Mailing Address - Fax:302-831-4468
Practice Address - Street 1:540 S COLLEGE AVE STE 160
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-1302
Practice Address - Country:US
Practice Address - Phone:302-831-8893
Practice Address - Fax:302-831-4468
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01659200225100000X
DEJ1-0004022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist