Provider Demographics
NPI:1699741090
Name:ARNOLD, JOHANN HEINRICH (RPA-C)
Entity type:Individual
Prefix:
First Name:JOHANN
Middle Name:HEINRICH
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HELLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5209
Mailing Address - Country:US
Mailing Address - Phone:845-658-7763
Mailing Address - Fax:
Practice Address - Street 1:105 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:RIFTON
Practice Address - State:NY
Practice Address - Zip Code:12471-7200
Practice Address - Country:US
Practice Address - Phone:845-658-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY221107OtherHMO
NY01981479Medicaid
NYMA0347977OtherDEA
NY0F198ER281Medicare ID - Type Unspecified
NYS69191Medicare UPIN
NY0F1981Medicare ID - Type Unspecified