Healthcare Provider Details

I. General information

NPI: 1578707253
Provider Name (Legal Business Name): RUTH A. JOHNSON, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 BROADWAY
ALDEN NY
14004
US

IV. Provider business mailing address

13500 BROADWAY
ALDEN NY
14004
US

V. Phone/Fax

Practice location:
  • Phone: 716-937-6743
  • Fax: 716-937-6453
Mailing address:
  • Phone: 716-937-6743
  • Fax: 716-937-6453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WENDY S ESS
Title or Position: OFFICE MANAGER
Credential:
Phone: 716-937-6743