Provider Demographics
NPI:1669663126
Name:JOHNSON, ANTHONY WHITNEY (LAC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WHITNEY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W 21ST ST
Mailing Address - Street 2:SUITE 1203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6904
Mailing Address - Country:US
Mailing Address - Phone:646-827-1325
Mailing Address - Fax:
Practice Address - Street 1:22 W 21ST ST
Practice Address - Street 2:SUITE 1203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6904
Practice Address - Country:US
Practice Address - Phone:646-827-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist