1386881977 NPI number — DMC ATHLETIC AND REHABILITATION, PC

Table of content: JONATHAN ASHELY COLLIS JOHNSON M.D. (NPI 1992953749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386881977 NPI number — DMC ATHLETIC AND REHABILITATION, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DMC ATHLETIC AND REHABILITATION, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386881977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
58B SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07960-9520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-984-0200
Provider Business Mailing Address Fax Number:
973-984-0210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58B SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-9520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-984-0200
Provider Business Practice Location Address Fax Number:
973-984-0210
Provider Enumeration Date:
01/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CUNIC
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-984-0200

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA01075000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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