Provider Demographics
NPI:1205232071
Name:JOHNSON, JAMES ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1995
Mailing Address - Country:US
Mailing Address - Phone:212-263-9700
Mailing Address - Fax:212-263-9701
Practice Address - Street 1:111 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006
Practice Address - Country:US
Practice Address - Phone:212-263-9700
Practice Address - Fax:212-263-9701
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1094213E00000X
CAE5334213E00000X, 213ES0103X
NY006967213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist