Provider Demographics
NPI:1821202169
Name:JOHNSTON, TAYLOR A (MD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:A
Last Name:JOHNSTON
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 1:1659 COLDEN AVE
Mailing Address - Street 2:APT #2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3147
Mailing Address - Country:US
Mailing Address - Phone:718-931-8063
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:PH 5-505
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234293207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology