Individual
MR. JESSE THOMAS JOHNSON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3201 KINGS HWY, BROOKLYN, NY 11234-2625
(718) 951-2901
Mailing address
3201 KINGS HWY, BROOKLYN, NY 11234-2625
(718) 951-2901
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
013190
NY
Other
Enumeration date
06/09/2009
Last updated
08/19/2016
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