MEDICARE: DR ROLAND JOHNKINS

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	13361	NJ

General Provider Information

NPI Number	:	1588841225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ROLAND JOHNKINS

Provider Business Mailing Address
First Line	:	24 MARE HAVEN CT
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4847
Country	:	US
Telephone Number	:	732-297-5799
Fax Number	:	732-297-8458

Provider Business Practice Location Address
First Line	:	24 MARE HAVEN CT
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4847
Country	:	US
Telephone Number	:	732-297-5799
Fax Number	:	732-297-8458

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ROLAND JOHNKINS
Credential	:	MD
Telephone Number	:	732-297-5799

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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