Healthcare Provider Details

I. General information

NPI: 1104506328
Provider Name (Legal Business Name): JOHANNA ANNE ANDREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 09/03/2026
Certification Date: 07/21/2023
Deactivation Date: 02/28/2024
Reactivation Date: 09/03/2026

III. Provider practice location address

345 E. 24TH STREET NEW YORK, NY 10010
NEW YORK CITY NY
10010
US

IV. Provider business mailing address

345 E. 24TH STREET NEW YORK, NY 10010 212-998-9800
NEW YORK CITY NY
10010
US

V. Phone/Fax

Practice location:
  • Phone: 212-998-9800
  • Fax:
Mailing address:
  • Phone: 212-998-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: