Individual
DEBORA JOHNSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 MONTAUK HWY, WEST ISLIP, NY 11795-4927
(631) 376-4118
Mailing address
11 IMPERIAL DR, MILLER PLACE, NY 11764-3225
(631) 504-7639
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
021623
NY
Other
Enumeration date
11/02/2017
Last updated
07/07/2021
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