Healthcare Provider Details

I. General information

NPI: 1669459855
Provider Name (Legal Business Name): PROFESSIONAL ORTHOPAEDIC ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 SHREWSBURY AVE SUITE 201
TINTON FALLS NJ
07724-3006
US

IV. Provider business mailing address

776 SHREWSBURY AVE SUITE 201
TINTON FALLS NJ
07724-3006
US

V. Phone/Fax

Practice location:
  • Phone: 732-530-4949
  • Fax: 732-530-3618
Mailing address:
  • Phone: 732-530-4949
  • Fax: 732-530-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER D JOHNSON
Title or Position: PHYSICIAN
Credential: MD
Phone: 732-530-4949