Provider Demographics
NPI:1225109846
Name:ROBERT WOOD JOHNSON MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:ROBERT WOOD JOHNSON MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-287-6663
Mailing Address - Street 1:2090 STATE ROUTE 27
Mailing Address - Street 2:PINES PLAZA
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3372
Mailing Address - Country:US
Mailing Address - Phone:732-287-6663
Mailing Address - Fax:732-287-6664
Practice Address - Street 1:337 APPLEGARTH RD
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-3721
Practice Address - Country:US
Practice Address - Phone:609-655-2411
Practice Address - Fax:609-655-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04896400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID#