Provider Demographics
NPI:1497804553
Name:JOHNSON, DAVID RICHARD (MS, MSAOM, LAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RICHARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS, MSAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1915
Mailing Address - Country:US
Mailing Address - Phone:201-670-8443
Mailing Address - Fax:201-612-7654
Practice Address - Street 1:1156 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3935
Practice Address - Country:US
Practice Address - Phone:201-670-8443
Practice Address - Fax:201-612-7654
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW05189900101YM0800X, 101YA0400X, 104100000X
NJ25MZ00053200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MZ00053200OtherNEW JERSEY ACUPUNCTURE LICENSE NUMBER
NJ25MZ00053200OtherNEW JERSEY ACUPUNCTURE LICENSE NUMBER