Provider Demographics
NPI:1083952097
Name:JOHNSON-MAXIM, ALEXIS ALIYHA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:ALIYHA
Last Name:JOHNSON-MAXIM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SUMMIT ST APT 317
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1502
Mailing Address - Country:US
Mailing Address - Phone:347-248-1313
Mailing Address - Fax:
Practice Address - Street 1:300 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1868
Practice Address - Country:US
Practice Address - Phone:973-822-2772
Practice Address - Fax:973-822-2773
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26NJ00951800363L00000X
NJ26NJ00951800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner