Individual
DONALD J JOHANNESSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
425 E 79TH ST, SUITE 1E, NEW YORK, NY 10021-1037
(212) 249-4739
(212) 737-5574
Mailing address
425 E 79TH ST, SUITE 1E, NEW YORK, NY 10021-1037
(212) 249-4739
(212) 737-5574
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
173503
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1557886
—
NY
Enumeration date
11/22/2006
Last updated
07/08/2007
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