Provider Demographics
NPI:1821814195
Name:JOHNSON, ROBERT LEE
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MARCY AVE APT 2P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-6446
Mailing Address - Country:US
Mailing Address - Phone:718-603-0811
Mailing Address - Fax:
Practice Address - Street 1:620 MARCY AVE APT 2P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-6446
Practice Address - Country:US
Practice Address - Phone:718-603-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist