Provider Demographics
NPI:1578947933
Name:JOHNSON, PATRICIA G (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 SAW MILL RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1050
Mailing Address - Country:US
Mailing Address - Phone:914-693-7636
Mailing Address - Fax:914-693-5994
Practice Address - Street 1:1055 SAW MILL RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1050
Practice Address - Country:US
Practice Address - Phone:914-693-7636
Practice Address - Fax:914-693-5994
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324608-1207Y00000X
PAMD474734207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology