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General NPI Number Information
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NPI Number | 1194029926
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Entity Type | Individual
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Provider Name | JOHANNES H DEJONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2011
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Last Update Date | 01/09/2011
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Provider Practice Location Address
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Address Line | 4 CAPTAIN BAILEY CT
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City | BRIELLE
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State | NJ
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Zip | 08730-1553
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Country | US
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Telephone | 732-785-0151
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Fax | 732-785-7761
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Provider Business Mailing Address
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Address Line | 4 CAPTAIN BAILEY CT
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City | BRIELLE
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State | NJ
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Zip | 08730-1553
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Country | US
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Telephone | 732-785-0151
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Fax | 732-785-7761
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | 25MA01868000
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License Number State | NJ
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