Individual
JENNIFER JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
3350 ROUTE 138 STE 126, WALL TOWNSHIP, NJ 07719-9694
(732) 280-6455
Mailing address
3600 ROUTE 66, FL 3, NEPTUNE, NJ 07753-2645
(732) 807-0877
(201) 751-1680
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
26NJ00668000
NJ
363LF0000X
Family Nurse Practitioner
Primary
26NJ00668000
NJ
Other
Enumeration date
09/20/2016
Last updated
05/08/2021
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