Healthcare Provider Details

I. General information

NPI: 1477794105
Provider Name (Legal Business Name): CHRISTOPHER LYNN JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHRIS JOHNSON M.D.

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W 48TH ST STE 300
NEW YORK NY
10036-1818
US

IV. Provider business mailing address

BOX 175 302A WEST 12TH STREET
NEW YORK NY
10014
US

V. Phone/Fax

Practice location:
  • Phone: 877-866-7123
  • Fax:
Mailing address:
  • Phone: 212-206-6996
  • Fax: 212-636-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number229970
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG77562
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG77562
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number229970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: