Healthcare Provider Details

I. General information

NPI: 1194741819
Provider Name (Legal Business Name): DAVID HENRY JOHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 NOSTRAND AVE BROOKLYN
BROOKLYN NY
11225-5417
US

IV. Provider business mailing address

1413 E 104TH ST APT 1
BROOKLYN NY
11236-4515
US

V. Phone/Fax

Practice location:
  • Phone: 718-778-0198
  • Fax: 718-221-8169
Mailing address:
  • Phone: 718-763-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number188736
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: