Individual
MR. JOHNNY WILLIE TAYLOR JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 MACOMBS RD, BRONX, NY 10452-2016
(718) 299-3300
Mailing address
1600 MACOMBS RD, BRONX, NY 10452-2016
(718) 299-3300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
24840
NY
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093883720
—
NY
Enumeration date
01/09/2018
Last updated
01/09/2018
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