Provider Demographics
NPI:1194741819
Name:JOHN, DAVID HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HENRY
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1413 E 104TH ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4515
Mailing Address - Country:US
Mailing Address - Phone:718-763-0237
Mailing Address - Fax:
Practice Address - Street 1:1167 NOSTRAND AVE
Practice Address - Street 2:BROOKLYN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5417
Practice Address - Country:US
Practice Address - Phone:718-778-0198
Practice Address - Fax:718-221-8169
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY188736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY00695941Medicaid
NYW6L111Medicare Oscar/Certification