Healthcare Provider Details

I. General information

NPI: 1548171424
Provider Name (Legal Business Name): JOHNNY MATHIS ASRL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 MEMORIAL PKWY UNIT 654
PHILLIPSBURG NJ
08865-7024
US

IV. Provider business mailing address

361 MEMORIAL PKWY UNIT 654
PHILLIPSBURG NJ
08865-7024
US

V. Phone/Fax

Practice location:
  • Phone: 908-899-1750
  • Fax:
Mailing address:
  • Phone: 908-899-1750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: