Individual
MRS. TIFFANY LYNN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
556 PASSAIC AVE, WEST CALDWELL, NJ 07006-7449
(973) 808-2273
Mailing address
18 REYNOLDS RD, PEQUANNOCK, NJ 07440-1707
(631) 327-2547
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
015417
NY
363AM0700X
Medical Physician Assistant
Primary
25MP00317300
NJ
Other
Enumeration date
06/19/2012
Last updated
03/17/2018
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