Provider Demographics
NPI:1760705719
Name:BAUX-JOHNSON, JAMIE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:BAUX-JOHNSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 EAGLE ROCK AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4229
Mailing Address - Country:US
Mailing Address - Phone:973-736-1365
Mailing Address - Fax:973-736-1366
Practice Address - Street 1:30 PROSPECT AVENUE
Practice Address - Street 2:2 CONKLIN
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:551-996-4024
Practice Address - Fax:551-996-0778
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09176700207RC0200X, 207P00000X, 207R00000X
NY60256157207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine