Provider Demographics
NPI:1083652010
Name:JOHN G JOHNSON ENTERPRISES, LLC
Entity Type:Organization
Organization Name:JOHN G JOHNSON ENTERPRISES, LLC
Other - Org Name:EVERFIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:856-829-0015
Mailing Address - Street 1:124 SWEDES RUN DR
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-2116
Mailing Address - Country:US
Mailing Address - Phone:856-461-8595
Mailing Address - Fax:
Practice Address - Street 1:2200 WALLACE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-2578
Practice Address - Country:US
Practice Address - Phone:856-829-0015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00276200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ109061Medicare PIN