Individual
ALYSIA JOHANSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, RD, CNSC
Contact information
Practice address
525 E 68TH ST, NEW YORK, NY 10065-4870
(212) 746-5454
Mailing address
525 E 68TH ST, NEW YORK, NY 10065-4870
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1004173
NJ
363A00000X
Physician Assistant
Primary
—
NY
Other
Enumeration date
03/01/2012
Last updated
09/10/2018
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