Healthcare Provider Details

I. General information

NPI: 1699111005
Provider Name (Legal Business Name): MALCOLM JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 08/15/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOUNT SINAI MEDICAL CENTER 25-10 30TH AVE
ASTORIA NY
11102
US

IV. Provider business mailing address

MT SINAI HOSPTIAL 25-10 30TH AVE
ASTORIA NY
11102
US

V. Phone/Fax

Practice location:
  • Phone: 718-932-1000
  • Fax:
Mailing address:
  • Phone: 718-932-1000
  • Fax: 203-785-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number55804
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number288266
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: