Basic Information
| Provider Information | |||||||||
| NPI: | 1356352397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | NORMAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 LOCKWOOD AVE | ||||||||
| Address2: | SUITE 28 | ||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146337870 | ||||||||
| FaxNumber: | 9146337626 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 LOCKWOOD AVE | ||||||||
| Address2: | SUITE 28 | ||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146337870 | ||||||||
| FaxNumber: | 9146337626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 189003 | NY | X | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 189003 | NY | X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 189003 | NY | X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 01363299 | 05 | NY | MEDICAID | 538650 | 01 | AETNA HMO | OTHER | 4251712 | 01 | AETNA | OTHER | 17742 | 01 | HHP | OTHER | 01226962 | 01 | UNITED | OTHER | 0D0933 | 01 | PHS | OTHER | 31257P | 01 | HIP | OTHER | W5388 | 01 | OXFORD | OTHER | 4536557013 | 01 | CIGNA | OTHER |