Provider Demographics
NPI:1568113900
Name:JOHNSON, ALICIA AURTHOLIA (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:AURTHOLIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3600
Mailing Address - Country:US
Mailing Address - Phone:917-301-4649
Mailing Address - Fax:
Practice Address - Street 1:21915 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1618
Practice Address - Country:US
Practice Address - Phone:917-301-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management