Healthcare Provider Details

I. General information

NPI: 1356963755
Provider Name (Legal Business Name): BRANDON B JOHNSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
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: 267-421-4838
Mailing address:
  • Phone: 917-284-6999
  • Fax: 917-551-5795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON B JOHNSON
Title or Position: PRACTICE OWNER
Credential: MD
Phone: 917-284-6999