Provider Demographics
NPI:1417219940
Name:JOHNSON, PATRICIA LAMPACH
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LAMPACH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 VIOLA RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3207
Mailing Address - Country:US
Mailing Address - Phone:845-357-6704
Mailing Address - Fax:
Practice Address - Street 1:120 N MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3743
Practice Address - Country:US
Practice Address - Phone:845-638-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist