Provider Demographics
NPI:1699038075
Name:JOHNSON, VIOLA EUNICE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:VIOLA
Middle Name:EUNICE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9226 AVENUE J FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3935
Mailing Address - Country:US
Mailing Address - Phone:718-968-2269
Mailing Address - Fax:718-968-2269
Practice Address - Street 1:9226 AVENUE J FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3935
Practice Address - Country:US
Practice Address - Phone:718-968-2269
Practice Address - Fax:718-968-2269
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist