Provider Demographics
NPI:1538111471
Name:DEGRAFT-JOHNSON, LATIFA JANICE JALALI (MD)
Entity type:Individual
Prefix:
First Name:LATIFA
Middle Name:JANICE JALALI
Last Name:DEGRAFT-JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LATIFA
Other - Middle Name:JANICE
Other - Last Name:JALALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:450 W 42ND ST APT 39D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6881
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:228 PARK AVE S # 76071
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1502
Practice Address - Country:US
Practice Address - Phone:646-863-1411
Practice Address - Fax:305-363-5044
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105724207Q00000X
NY237874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine