Provider Demographics
NPI:1548817083
Name:CLJOHNSONMD PC
Entity type:Organization
Organization Name:CLJOHNSONMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-271-0156
Mailing Address - Street 1:22 W 48TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-1818
Mailing Address - Country:US
Mailing Address - Phone:212-271-0156
Mailing Address - Fax:212-656-1325
Practice Address - Street 1:22 W 48TH ST STE 300
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-1818
Practice Address - Country:US
Practice Address - Phone:212-271-0156
Practice Address - Fax:212-656-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty