Healthcare Provider Details

I. General information

NPI: 1538428578
Provider Name (Legal Business Name): JOHAN A PICARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 WASHINGTON ST
HOBOKEN NJ
07030-4907
US

IV. Provider business mailing address

609 WASHINGTON ST
HOBOKEN NJ
07030-4907
US

V. Phone/Fax

Practice location:
  • Phone: 201-659-7700
  • Fax:
Mailing address:
  • Phone: 201-659-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09338800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: