Individual
LISA MARGUERITE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 E 77TH ST, SUITE 1A, NEW YORK, NY 10075-2303
(212) 861-2564
(212) 861-2569
Mailing address
400 E 77TH ST, SUITE 1A, NEW YORK, NY 10075-2303
(212) 861-2564
(212) 861-2569
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
206723
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01991588
—
NY
01
—
A300038567
MEDICARE PTAN
NY
Enumeration date
09/14/2006
Last updated
09/23/2015
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