Provider Demographics
NPI:1013665835
Name:JOHNSON, LEYLA CHALA (PA-C)
Entity type:Individual
Prefix:
First Name:LEYLA
Middle Name:CHALA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 5TH AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2681
Mailing Address - Country:US
Mailing Address - Phone:212-444-8006
Mailing Address - Fax:
Practice Address - Street 1:923 5TH AVE APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2681
Practice Address - Country:US
Practice Address - Phone:212-444-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085008946363A00000X
NY032092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant