Healthcare Provider Details

I. General information

NPI: 1598947392
Provider Name (Legal Business Name): JOHNSON CHRISTOPHER EBOKOSIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 N BROAD ST
PHILADELPHIA PA
19132-4013
US

IV. Provider business mailing address

2514 NORTH BROAD STREET
PHILADELPHIA PA
19132
US

V. Phone/Fax

Practice location:
  • Phone: 215-599-2830
  • Fax: 215-599-1042
Mailing address:
  • Phone: 215-599-2830
  • Fax: 215-599-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: