Provider Demographics
NPI:1689751497
Name:JOHNSON, MAURICE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 NICHOLAS WAY
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2782
Mailing Address - Country:US
Mailing Address - Phone:845-628-0838
Mailing Address - Fax:
Practice Address - Street 1:1985 CROMPOND RD
Practice Address - Street 2:BUILDING C
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4146
Practice Address - Country:US
Practice Address - Phone:914-739-7505
Practice Address - Fax:914-739-7568
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCK6625OtherRAILROAD
NY01164938Medicaid
NY01164938Medicaid
NYE87311Medicare UPIN
NY34F681Medicare PIN