Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 25MA10659400 | NJ |
NPI | 1003178682 |
---|---|
Provider Name | Stephen A Johnson |
First Address | New Brunswick, NJ 08901-2065 |
Second Address | New Brunswick, NJ 08901-2065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2012 |
Last Update Date | 17/09/2019 |