Provider Demographics
NPI:1457160392
Name:JOHNSON, ROZANO ISMAEL (CPS)
Entity type:Individual
Prefix:MR
First Name:ROZANO
Middle Name:ISMAEL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 PARK AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1923
Mailing Address - Country:US
Mailing Address - Phone:201-774-2164
Mailing Address - Fax:
Practice Address - Street 1:1767 PARK AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1923
Practice Address - Country:US
Practice Address - Phone:917-697-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P22766175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist