Provider Demographics
NPI:1689456071
Name:JOHNSTON, ELIZABETH EVA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EVA
Last Name:JOHNSTON
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 1:811 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1358
Mailing Address - Country:US
Mailing Address - Phone:917-992-0328
Mailing Address - Fax:
Practice Address - Street 1:825 7TH AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6014
Practice Address - Country:US
Practice Address - Phone:332-259-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program