Individual
JUSTIN JOHANNESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
177 FORT WASHINGTON AVE, NEW YORK, NY 10032-3733
(212) 305-9875
(212) 305-9049
Mailing address
177 FORT WASHINGTON AVE, NEW YORK, NY 10032-3733
(212) 305-9875
(212) 305-9049
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD457605
PA
207RC0000X
Cardiovascular Disease Physician
Primary
310559
NY
Other
Enumeration date
07/16/2013
Last updated
05/27/2022
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