Provider Demographics
NPI:1487917480
Name:NATALIE JOHNSON, MD, PC
Entity type:Organization
Organization Name:NATALIE JOHNSON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:973-243-0290
Mailing Address - Street 1:470 PROSPECT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4153
Mailing Address - Country:US
Mailing Address - Phone:973-243-0292
Mailing Address - Fax:973-243-1863
Practice Address - Street 1:470 PROSPECT AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4106
Practice Address - Country:US
Practice Address - Phone:973-243-0290
Practice Address - Fax:973-243-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06341400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ026701Medicare PIN