Individual
JOHNNY LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
600 RIVER AVE, KIMBALL MEDICAL CENTER, LAKEWOOD, NJ 08701-5237
(732) 363-1900
Mailing address
PO BOX 717, LIVINGSTON, NJ 07039-0717
(973) 740-0607
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MB05391100
NJ
Other
Enumeration date
07/19/2006
Last updated
07/08/2007
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