Provider Demographics
NPI:1528150281
Name:JOHNSTON, ROBERT BRIAN
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRIAN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 TENNENT RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3412
Mailing Address - Country:US
Mailing Address - Phone:732-786-0525
Mailing Address - Fax:
Practice Address - Street 1:51 BREWSTER CIR
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3612
Practice Address - Country:US
Practice Address - Phone:732-918-8075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 05421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU62977Medicare UPIN
NJ892978Medicare ID - Type Unspecified