Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 298713 | NY |
NPI | 1154741965 |
---|---|
Provider Name | William Johnson |
First Address | New York, NY 10016-6402 |
Second Address | New York, NY 10016-6402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2014 |
Last Update Date | 02/08/2021 |