Provider Demographics
NPI:1336158831
Name:JOHNSON, REBECCA M (PAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 70TH ST
Mailing Address - Street 2:HOSPITAL FOR SPECIAL SURGERY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4823
Mailing Address - Country:US
Mailing Address - Phone:212-606-1000
Mailing Address - Fax:
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:HOSPITAL FOR SPECIAL SURGERY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4823
Practice Address - Country:US
Practice Address - Phone:212-606-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002312363A00000X
IL085002312363A00000X
NY016545-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0739010008OtherMEDICARE NSC
ILCD4744OtherRAILROAD MEDICARE GROUP #
IL0739010006OtherMEDICARE NSC
P00332367OtherRAILROAD MEDICARE PIN #
IL0739010001OtherMEDICARE NSC
IL0739010005OtherMEDICARE NSC
ILP00332367OtherRAILROAD MEDICARE
P00332367OtherRR MEDICARE
K16326Medicare PIN
P00332367OtherRR MEDICARE
P00332367OtherRAILROAD MEDICARE PIN #
IL0739010005OtherMEDICARE NSC
IL0739010006OtherMEDICARE NSC
ILK16327Medicare PIN
0739010005Medicare NSC
IL208592Medicare PIN
K16327Medicare UPIN
ILP00332367OtherRAILROAD MEDICARE
Q40279Medicare UPIN
ILQ40279Medicare UPIN