Healthcare Provider Details

I. General information

NPI: 1659957553
Provider Name (Legal Business Name): JESSICA JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WESTCHESTER AVE
WEST HARRISON NY
10604-2901
US

IV. Provider business mailing address

194 ROCKLAND AVE
NORWOOD NJ
07648-1317
US

V. Phone/Fax

Practice location:
  • Phone: 916-682-0700
  • Fax:
Mailing address:
  • Phone: 207-742-2284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number330582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: