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Individual

KEVIN JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1045 JAMES STREET, SYRACUSE, NY 13203
(315) 472-4471
(315) 999-1377
Mailing address
129 SADDLESTONE PL APT A, CAMILLUS, NY 13031-1688
(248) 914-8091

Taxonomy

Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
294176
NY
2084P0800X
Psychiatry Physician
294176
NY

Other

Enumeration date
04/28/2014
Last updated
09/16/2024
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