Individual
LAKEIA D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 CENTRAL AVE, NEWARK, NJ 07102-1909
(973) 877-5000
Mailing address
434 HOLLYWOOD AVE, HILLSIDE, NJ 07205-2716
(908) 400-1996
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
25MP00158500
NJ
363AS0400X
Surgical Physician Assistant
Primary
25MP00158500
NJ
Other
Enumeration date
10/22/2007
Last updated
10/22/2007
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