Individual
JOHANNA JACQUELINE GONZALEZ MEJIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
433 NORTH BROAD STREET, ELIZABETH, NJ 07208-3398
(908) 436-1002
(908) 436-1109
Mailing address
433 NORTH BROAD STREET, ELIZABETH, NJ 07208-3398
(908) 436-1002
(908) 436-1109
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA06899700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01000296602
AMERICHOICE
NJ
01
—
202092816
TAX ID,
NJ
01
—
31002
UNIVERSITY HEALTH PLAN
NJ
01
—
60013229
HORIZON NJ HEALTH
NJ
01
—
7752202
AETNA
NJ
05
—
8565708
—
NJ
01
—
97222
AMERIGROUP
NJ
01
—
AH0236165301
AMERIHEALTH
NJ
Enumeration date
10/02/2006
Last updated
07/09/2007
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