Provider Demographics
NPI:1689269607
Name:JOHNSON, TROY J JR
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:J
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08063-1441
Mailing Address - Country:US
Mailing Address - Phone:856-870-7550
Mailing Address - Fax:
Practice Address - Street 1:1109 SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08063-1441
Practice Address - Country:US
Practice Address - Phone:856-870-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker