Provider Demographics
NPI:1326145590
Name:JOHNSON, GEORGE A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:375 MOUNT PLEASANT AVE STE 250
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2751
Practice Address - Country:US
Practice Address - Phone:973-323-1320
Practice Address - Fax:973-323-1320
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0361000208800000X
NJ25MA03619000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA03619000OtherLICENSE#
NJ3662608Medicaid
NJD99004Medicare UPIN