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NPI Code Detail

MEDICARE: DR. BEVERLY JOHNSON MD

MEDICARE: DR. BEVERLY JOHNSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician247479NY
2207RR0500XRheumatology Physician247479NY

General Provider Information

NPI Number : 1336306992
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BEVERLY JOHNSON MD
Provider Business Mailing Address
First Line : 1400 PELHAM PKWY S RM 3N-21E
Second Line :
City : BRONX
State : NY
Zip : 10461-1119
Country : US
Telephone Number : 718-918-3015
Fax Number : 718-918-7460
Provider Business Practice Location Address
First Line : 1400 PELHAM PARKWAY SOUTH JACOBI MEDICAL CENTER
Second Line : ROOM 3N-06
City : BRONX
State : NY
Zip : 10461-1197
Country : US
Telephone Number : 718-918-3015
Fax Number : 718-918-7460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2008
Last Update Date : 11/19/2023

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Directions to “ DR. BEVERLY JOHNSON MD” Practice Location

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