Healthcare Provider Details

I. General information

NPI: 1255080313
Provider Name (Legal Business Name): SAMUEL HAYDEN JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

1000 10TH AVE RM 3A-02
NEW YORK NY
10019-1147
US

V. Phone/Fax

Practice location:
  • Phone: 212-259-6777
  • Fax:
Mailing address:
  • Phone: 212-259-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number341534
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: