Provider Demographics
NPI:1992709828
Name:JOHNSON, ALBERT (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2921
Mailing Address - Country:US
Mailing Address - Phone:908-722-0822
Mailing Address - Fax:908-722-6318
Practice Address - Street 1:1081 ROUTE 22
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2921
Practice Address - Country:US
Practice Address - Phone:908-722-0822
Practice Address - Fax:908-722-6318
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03047500207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1433202Medicaid
NJD99904Medicare UPIN
NJ145186BMNMedicare PIN