Basic Information
| Provider Information | |||||||||
| NPI: | 1003178682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 PLUM ST DEPT OF | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089012065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322356333 | ||||||||
| FaxNumber: | 4126476483 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 PLUM ST DEPT OF | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089012065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322356333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 25MA10659400 | NJ | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.