Provider Demographics
NPI:1700088952
Name:SMITH, DAVID EUGENE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EUGENE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NEW RD
Mailing Address - Street 2:STE 120
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1152
Mailing Address - Country:US
Mailing Address - Phone:609-926-9600
Mailing Address - Fax:609-653-9352
Practice Address - Street 1:30 SERENE LN
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5690
Practice Address - Country:US
Practice Address - Phone:973-951-0835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA082179002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0135640Medicaid
NJ113650C60Medicare PIN