Basic Information
| Provider Information | |||||||||
| NPI: | 1942758859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHANSEN | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 ROUTE 66 | ||||||||
| Address2: | FL 3 | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077532645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328070877 | ||||||||
| FaxNumber: | 2017511680 | ||||||||
| Practice Location | |||||||||
| Address1: | 3350 ROUTE 138 STE 126 | ||||||||
| Address2: | |||||||||
| City: | WALL TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077199694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322806455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2016 | ||||||||
| LastUpdateDate: | 05/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 26NJ00668000 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | 363LF0000X | 26NJ00668000 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.