Provider Demographics
NPI:1598101537
Name:JOHNSON, ALLISON RACHEL
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:RACHEL
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 1:39 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5201
Mailing Address - Country:US
Mailing Address - Phone:516-353-4773
Mailing Address - Fax:
Practice Address - Street 1:39 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5201
Practice Address - Country:US
Practice Address - Phone:516-353-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY719701131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist