Provider Demographics
NPI:1902366883
Name:JOHNSON, MICHAEL ISAAC (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ISAAC
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:ISAAC
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2742 BROWN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1612
Mailing Address - Country:US
Mailing Address - Phone:716-495-2522
Mailing Address - Fax:
Practice Address - Street 1:46 LITTLE EAST NECK RD
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2509
Practice Address - Country:US
Practice Address - Phone:631-482-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN00728501213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery