| Organization Name: | JOHNSON & PARK HEALTHY CHOICE LLC |
| NPI Number: | 1326343468 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRACEY JOHNSON (M.D.) |
| Mailing Address: | 142-25 37th Ave., #c3 Flushing |
| State: | NY US |
| Postal Code: | 113546530 |
| Phone Number: | 7183593777 |
| Fax Number: | |
| NPI Enumeration Date: | 01/21/2011 |
| NPI Last Update Date: | 01/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 258418 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |