MEDICARE: MID-ESSEX UROLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		NJ

General Provider Information

NPI Number	:	1194867275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ESSEX UROLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	258 CENTRAL AVE # 264
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-3414
Country	:	US
Telephone Number	:	973-677-1144
Fax Number	:	973-677-9145

Provider Business Practice Location Address
First Line	:	258 CENTRAL AVE # 264
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-3414
Country	:	US
Telephone Number	:	973-677-1144
Fax Number	:	973-677-9145

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. GEORGE A JOHNSON JR.
Credential	:	MD
Telephone Number	:	973-677-1144

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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