Healthcare Provider Details

I. General information

NPI: 1386806693
Provider Name (Legal Business Name): BRANDON B JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E 32ND ST
NEW YORK NY
10016-6002
US

IV. Provider business mailing address

161 E 32ND ST
NEW YORK NY
10016-6002
US

V. Phone/Fax

Practice location:
  • Phone: 212-979-2020
  • Fax: 646-589-0599
Mailing address:
  • Phone: 212-979-2020
  • Fax: 646-589-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number274402
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: