Healthcare Provider Details

I. General information

NPI: 1992709828
Provider Name (Legal Business Name): ALBERT JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 ROUTE 22
BRIDGEWATER NJ
08807-2921
US

IV. Provider business mailing address

1081 ROUTE 22
BRIDGEWATER NJ
08807-2921
US

V. Phone/Fax

Practice location:
  • Phone: 908-722-0822
  • Fax: 908-722-6318
Mailing address:
  • Phone: 908-722-0822
  • Fax: 908-722-6318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA03047500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: