Provider Demographics
NPI:1386806693
Name:JOHNSON, BRANDON B (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6002
Mailing Address - Country:US
Mailing Address - Phone:212-979-2020
Mailing Address - Fax:646-589-0599
Practice Address - Street 1:161 E 32ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6002
Practice Address - Country:US
Practice Address - Phone:212-979-2020
Practice Address - Fax:646-589-0599
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274402207W00000X
GA67482207W00000X
PAMT193551208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208600000XAllopathic & Osteopathic PhysiciansSurgery