Healthcare Provider Details

I. General information

NPI: 1528087517
Provider Name (Legal Business Name): AMY JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 08/14/2007

III. Provider practice location address

1 GUSTAVE L LEVY PLACE #1230
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PLACE #1230
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8806
  • Fax: 212-849-2682
Mailing address:
  • Phone: 212-659-8806
  • Fax: 212-849-2682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number231096
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: