Individual
AHRA JOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 GUSTAVE L PLACE, BOX 1149, NEW YORK, NY 10029
(212) 824-8069
Mailing address
1 GUSTAVE L PLACE, BOX 1149, NEW YORK, NY 10029
(212) 824-8069
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD2021-0765
NM
Other
Enumeration date
03/22/2017
Last updated
03/28/2022
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