Healthcare Provider Details

I. General information

NPI: 1134046055
Provider Name (Legal Business Name): PAULINE IONIE JOHNSON-LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23608 138TH AVE
ROSEDALE NY
11422-1710
US

IV. Provider business mailing address

23608 138TH AVE
ROSEDALE NY
11422-1710
US

V. Phone/Fax

Practice location:
  • Phone: 516-452-9299
  • Fax:
Mailing address:
  • Phone: 516-452-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number395487
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: