Healthcare Provider Details

I. General information

NPI: 1386610319
Provider Name (Legal Business Name): ANDREW JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 03/07/2023
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE
LONG BRANCH NJ
07740-6303
US

IV. Provider business mailing address

68 S SERVICE RD STE 350
MELVILLE NY
11747-2354
US

V. Phone/Fax

Practice location:
  • Phone: 732-222-5200
  • Fax:
Mailing address:
  • Phone: 516-945-3357
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MB07617400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MB07617400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MB07617400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: