Haskell Towne Medical, LLC
Organization Active NPI Primary Care Clinic/Center · Haskell, NJ
NPI 1497948665 · NPPES record last updated Oct 7, 2015
Key facts
- NPI
- 1497948665
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 25MB07737100 (NJ)
- Legal business name
- HASKELL TOWNE MEDICAL, LLC
- Practice address
- 1141 Ringwood Ave
Suite 7
Haskell, NJ 07420-1565 - Phone
- (973) 835-6777
- NPI assigned
- Aug 21, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeffrey Todd Smith, D.O.
- Title
- Physician, Owner
- Phone
- (973) 835-6777
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 31D1066463 | Haskell Towne Medical | Certificate of waiver | Mar 25, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070929000014 | NJ | Part B Supplier - Clinic/Group Practice | 9830284298 |
Receives reassigned benefits from 1 practitioner Practice locations: Haskell, NJ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 25MB07737100 | NJ | Yes |
Addresses
Primary practice location
1141 Ringwood Ave
Suite 7
Haskell, NJ 07420-1565
Mailing address
1141 Ringwood Ave
Suite 7
Haskell, NJ 07420-1565
Phone (973) 835-6777
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- Nancy Marie Gitin
- Mary N Guenther
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- Cindy Har
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- Jeannine Kressaty
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All providers in Haskell, NJ · Primary Care Clinic/Center in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.