Provider Demographics
NPI:1265510549
Name:JOHNSON, MARIA ANGELA (26NJ00539700)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:26NJ00539700
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 TREMONT AVE
Mailing Address - Street 2:P. O. BOX 1392
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1023
Mailing Address - Country:US
Mailing Address - Phone:973-696-1000
Mailing Address - Fax:908-428-7255
Practice Address - Street 1:385 TREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1023
Practice Address - Country:US
Practice Address - Phone:973-696-1000
Practice Address - Fax:908-428-7255
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00539700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health