Individual
STANLEY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
27005 76TH AVE, NEW HYDE PARK, NY 11040-1402
(718) 470-7000
Mailing address
594 HEATHCOTE RD, LINDENHURST, NY 11757-1822
(631) 988-0602
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
024264
NY
Other
Enumeration date
10/14/2019
Last updated
11/07/2019
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