Provider Demographics
NPI:1740511872
Name:JOHNSTON, EMILY ANNE (RD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1112
Mailing Address - Country:US
Mailing Address - Phone:201-656-1042
Mailing Address - Fax:201-656-7656
Practice Address - Street 1:1401 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4236
Practice Address - Country:US
Practice Address - Phone:973-759-9000
Practice Address - Fax:973-759-2487
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10106543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ219716Medicare PIN