Provider Demographics
NPI:1356352397
Name:JOHNSON, MICHAEL NORMAN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NORMAN
Last Name:JOHNSON
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 1:150 LOCKWOOD AVE
Mailing Address - Street 2:SUITE 28
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-633-7870
Mailing Address - Fax:914-633-7626
Practice Address - Street 1:150 LOCKWOOD AVE
Practice Address - Street 2:SUITE 28
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-633-7870
Practice Address - Fax:914-633-7626
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189003207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Not Answered207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01363299Medicaid
538650OtherAETNA HMO
4251712OtherAETNA
17742OtherHHP
01226962OtherUNITED
0D0933OtherPHS
31257POtherHIP
W5388OtherOXFORD
4536557013OtherCIGNA
31257POtherHIP
17742OtherHHP
56K951Medicare ID - Type Unspecified