Provider Demographics
NPI:1588841225
Name:DR ROLAND JOHNKINS
Entity Type:Organization
Organization Name:DR ROLAND JOHNKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-297-5799
Mailing Address - Street 1:24 MARE HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4847
Mailing Address - Country:US
Mailing Address - Phone:732-297-5799
Mailing Address - Fax:732-297-8458
Practice Address - Street 1:24 MARE HAVEN CT
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4847
Practice Address - Country:US
Practice Address - Phone:732-297-5799
Practice Address - Fax:732-297-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ13361207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty