Individual
COLLEEN BREEN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11 MEDICAL DR, PORT JEFFERSON STATION, NY 11776-1589
(631) 509-6066
Mailing address
120 LEBRUN AVE, AMITYVILLE, NY 11701-4249
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
020304
NY
363A00000X
Physician Assistant
Primary
020304-1
NY
Other
Enumeration date
03/11/2011
Last updated
09/27/2018
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