Healthcare Provider Details

I. General information

NPI: 1063637726
Provider Name (Legal Business Name): STEPHANIE C JOHNSTON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 PLANDOME RD
MANHASSET NY
11030-1937
US

IV. Provider business mailing address

145 SHORE RD
MANHASSET NY
11030-1350
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-5050
  • Fax:
Mailing address:
  • Phone: 516-627-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301689-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: