Provider Demographics
NPI:1114273547
Name:NATALIE JOHNSON, MD., PC
Entity Type:Organization
Organization Name:NATALIE JOHNSON, MD., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, PC
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:ALVES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN
Authorized Official - Phone:973-243-0290
Mailing Address - Street 1:470 PROSPECT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4153
Mailing Address - Country:US
Mailing Address - Phone:973-243-0290
Mailing Address - Fax:
Practice Address - Street 1:470 PROSPECT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4153
Practice Address - Country:US
Practice Address - Phone:973-243-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06341400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty