Healthcare Provider Details

I. General information

NPI: 1114928652
Provider Name (Legal Business Name): DAVID L JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 ROUTE 33 SUITE 201
NEPTUNE NJ
07753-4862
US

IV. Provider business mailing address

100 MADISON AVE MID ATLANTIC SURGICAL ASSOC
MORRISTOWN NJ
07960-6136
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4622
  • Fax: 732-776-3765
Mailing address:
  • Phone: 973-971-7300
  • Fax: 973-984-7019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number62117
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: