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General NPI Number Information
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NPI Number | 1639040256
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Entity Type | Individual
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Provider Name | DR. NEVIN JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 240 MEETING HOUSE LN
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5009
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Country | US
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Telephone | 631-726-8520
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Fax |
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Provider Business Mailing Address
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Address Line | 240 BERNICE DR
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City | EAST MEADOW
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State | NY
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Zip | 11554-3502
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Country | US
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Telephone | 516-368-4907
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 054163-01
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License Number State | NY
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