Provider Demographics
NPI:1730718834
Name:TRUONG, JOHNNY (DO)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 NORTH BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591
Mailing Address - Country:US
Mailing Address - Phone:914-269-1730
Mailing Address - Fax:914-631-0797
Practice Address - Street 1:362 NORTH BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591
Practice Address - Country:US
Practice Address - Phone:914-269-1730
Practice Address - Fax:914-631-0797
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY320630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program