Most Relevant Information
Provider Data
| NPI Number: | 1003042664 |
| Provider Name: | JESSE THOMAS JOHNSON PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: | 013190 |
Most Important Dates
| Enumeration Date: | 06/09/2009 |
| Last Updated: | 08/19/2016 |
Provider Practice Location
3201 KINGS HWY
BROOKLYN
NY
112342625
Practice Location Phone/Fax
| Phone: | 7189512901 |
| Fax: |
Provider Mailing Location
3201 KINGS HWY
BROOKLYN
NY
112342625
Provider Mailing Phone/Fax
| Phone: | 7189512901 |
| Fax: |