Doctor Name: | ALEXANDER JOHNSON |
NPI Number: | 1083049860 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | AW-2383153-160 |
Business Practice Address: | 64 Robbins St Waterbury, CT - 067082613 |
Business Phone Number: | 7185795874 |
Business Fax Number: | 7185794836 |
Mailing Address: | 257 W 97th St, NEW YORK |
State: | NY |
Postal Code: | 100256219 |
Phone Number: | 6463512652 |
Fax Number: | |
NPI Enumeration Date: | 09/11/2013 |
NPI Last Update Date: | 09/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | AW-2383153-160 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |