Provider Demographics
NPI:1396064341
Name:PEREIRA, JOHNSON (MD)
Entity type:Individual
Prefix:
First Name:JOHNSON
Middle Name:
Last Name:PEREIRA
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 1:140 W 69TH ST
Mailing Address - Street 2:APT#79B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5107
Mailing Address - Country:US
Mailing Address - Phone:718-928-4016
Mailing Address - Fax:718-928-4016
Practice Address - Street 1:140 W 69TH ST
Practice Address - Street 2:APT# 79 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5107
Practice Address - Country:US
Practice Address - Phone:718-928-4016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447256207R00000X
NY272960208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist