MEDICARE: DR. TIMOTHY C JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	229556	NY
2	207RG0100X	Gastroenterology Physician	229556	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801895248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY C JOHNSON M.D.

Provider Business Mailing Address
First Line	:	128 MOTT ST
Second Line	:	SUITE 202
City	:	NEW YORK
State	:	NY
Zip	:	10013-5540
Country	:	US
Telephone Number	:	646-355-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 MOTT ST
Second Line	:	SUITE 202
City	:	NEW YORK
State	:	NY
Zip	:	10013-5540
Country	:	US
Telephone Number	:	646-355-3711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/30/2015

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