Provider Demographics
NPI:1194029926
Name:DEJONG, JOHANNES H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNES
Middle Name:H
Last Name:DEJONG
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 1:4 CAPTAIN BAILEY CT
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1553
Mailing Address - Country:US
Mailing Address - Phone:732-785-0151
Mailing Address - Fax:732-785-7761
Practice Address - Street 1:4 CAPTAIN BAILEY CT
Practice Address - Street 2:
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1553
Practice Address - Country:US
Practice Address - Phone:732-785-0151
Practice Address - Fax:732-785-7761
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-09
Last Update Date:2011-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01868000202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner