Healthcare Provider Details

I. General information

NPI: 1982809281
Provider Name (Legal Business Name): ARIEL JOHNSON CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1822
US

IV. Provider business mailing address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1822
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5741
  • Fax: 718-604-6742
Mailing address:
  • Phone: 718-604-5741
  • Fax: 718-604-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number004142
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: