Provider Demographics
NPI:1477746543
Name:JOHNSON, TYRONE (DPM)
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 DEAN ST APT 714
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3484
Mailing Address - Country:US
Mailing Address - Phone:516-305-7951
Mailing Address - Fax:929-298-7367
Practice Address - Street 1:1040 DEAN ST APT 714
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3484
Practice Address - Country:US
Practice Address - Phone:516-305-7951
Practice Address - Fax:929-298-7367
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006234174400000X, 213E00000X
NY65 006234213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No174400000XOther Service ProvidersSpecialist
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist