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General NPI Number Information
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NPI Number | 1417727819
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Entity Type | Individual
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Provider Name | JON RAY JOHNSON MA
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Gender | Male
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Dates
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Enumeration Date | 01/05/2024
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 1400 OLD COUNTRY RD STE C103N
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City | WESTBURY
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State | NY
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Zip | 11590-5156
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Country | US
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Telephone | 516-806-6969
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Fax |
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Provider Business Mailing Address
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Address Line | 130 FIREFIGHTERS MEMORIAL DR # 291
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City | FORT MONTGOMERY
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State | NY
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Zip | 10922-9800
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Country | US
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Telephone | 347-265-0199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1654421221
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License Number State | NY
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