Doctor Name: | MR. JESSE THOMAS JOHNSON |
NPI Number: | 1003042664 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | 013190 |
Business Practice Address: | 53 Ronald Dr N Amityville, NY - 117012332 |
Business Phone Number: | 5162442382 |
Business Fax Number: | |
Mailing Address: | 53 Ronald Dr N, AMITYVILLE |
State: | NY |
Postal Code: | 117012332 |
Phone Number: | 5162442382 |
Fax Number: | |
NPI Enumeration Date: | 06/09/2009 |
NPI Last Update Date: | 06/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 013190 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |