Active NPI
Colleen Ellen Johnson, M.S,, R.D.
- Registered Dietitian
- West Orange, NJ
National Provider Identifier
1366797268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 720084
- Practice address
- 200 Mount Pleasant Ave
Apt. D2
West Orange, NJ 07052-4049 - Phone
- (973) 632-4505
- NPI assigned
- Jul 17, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 720084 | NJ | Primary |
Addresses
Primary practice location
200 Mount Pleasant Ave
Apt. D2
West Orange, NJ 07052-4049
Mailing address
200 Mount Pleasant Ave
Apt. D2
West Orange, NJ 07052-4049
Phone (973) 632-4505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 720084 | NJ | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342483200000",
"number": "1366797268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 MOUNT PLEASANT AVE",
"address_2": "APT. D2",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "070524049",
"telephone_number": "973-632-4505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MOUNT PLEASANT AVE",
"address_2": "APT. D2",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "070524049",
"telephone_number": "973-632-4505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "COLLEEN",
"middle_name": "ELLEN",
"name_prefix": "Ms.",
"credential": "M.S,, R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-17",
"last_updated": "2012-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NJ",
"license": "720084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.