Provider Demographics
NPI:1972048171
Name:JOHNSON, MADELINE (RT)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E 86TH ST APT 16C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4750
Mailing Address - Country:US
Mailing Address - Phone:917-861-5292
Mailing Address - Fax:
Practice Address - Street 1:4675 CORNELL RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2461
Practice Address - Country:US
Practice Address - Phone:513-272-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORTL1229227800000X
NJ43ZA00004673227800000X
KY6463227800000X
FLTTL16188227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified