Provider Demographics
NPI:1730684903
Name:JOHNSON, JEFFREY PACE (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PACE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:161 FORT WASHINGTON AVE FL 11
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-0114
Mailing Address - Fax:212-305-0116
Practice Address - Street 1:161 FORT WASHINGTON AVE FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-0114
Practice Address - Fax:212-305-0116
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY331137208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology