Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 137315 | NY |
Y | 2080P0210X | Pediatric Nephrologist | 137315 | NY |
NPI | 1033207311 |
---|---|
Provider Name | Valerie L Johnson |
First Address | New York, NY 10021-4635 |
Second Address | New York, NY 10021-4635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 19/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00845661 | (05) | NY |
C07418 | (02) | NY |