Healthcare Provider Details

I. General information

NPI: 1033207311
Provider Name (Legal Business Name): VALERIE L JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 E 72ND ST OFC 100
NEW YORK NY
10021-4635
US

IV. Provider business mailing address

428 E 72ND ST OFC 100
NEW YORK NY
10021-4635
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-3260
  • Fax: 212-746-3988
Mailing address:
  • Phone: 212-746-0373
  • Fax: 212-746-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number137315
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number137315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: