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General NPI Number Information
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NPI Number | 1518339951
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Entity Type | Individual
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Provider Name | MR. BENJAMIN JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 2211 GENESEE ST
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City | UTICA
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State | NY
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Zip | 13501-5930
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Country | US
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Telephone | 315-793-1198
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Fax | 315-733-3142
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Provider Business Mailing Address
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Address Line | 201 MARION ST
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City | HERKIMER
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State | NY
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Zip | 13350-2111
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Country | US
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Telephone | 315-868-2063
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 23 019290
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License Number State | NY
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