Provider Demographics
NPI:1194223933
Name:FOREFRONT-JOHNSON MEDICAL SERVICE CORPORATION
Entity Type:Organization
Organization Name:FOREFRONT-JOHNSON MEDICAL SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMALON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-909-1027
Mailing Address - Street 1:3500 QUAKERBRIDGE RD # 105
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1206
Mailing Address - Country:US
Mailing Address - Phone:866-959-2008
Mailing Address - Fax:888-972-2903
Practice Address - Street 1:3500 QUAKERBRIDGE RD # 105
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1206
Practice Address - Country:US
Practice Address - Phone:866-959-2008
Practice Address - Fax:888-972-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty