Donald J Johannessen, MD

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

173503 Issued in NY

Practice address

425 E 79TH St
Suite 1E
New York, NY 10021-1037

Phone

(212) 249-4739

Fax

(212) 737-5574

NPI assigned

Nov 22, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2014 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295800142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 E 79TH ST",
            "address_2": "SUITE 1E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100211037",
            "telephone_number": "212-249-4739",
            "fax_number": "212-737-5574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 E 79TH ST",
            "address_2": "SUITE 1E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100211037",
            "telephone_number": "212-249-4739",
            "fax_number": "212-737-5574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANNESSEN",
        "first_name": "DONALD",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "NY",
            "license": "173503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1557886",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Johanna Berger, PHD, Psychologist, PLLC
• Johanna Youner, DPM
• Maya Anna Johannes
• Claire Patricia Johannesen, DPT
• Justin Johannesen, M.D.
• Christopher Martin Johannet, M.D.
• Paul Johannet
• Barbara Burton Johanns, PHYSICIAN ASSISTANT
• Estelle Marie Johansen, AGACNP-BC, RN
• Michael Johansen

• Geriatric Psychiatry Physician in New York, NY
• Providers in New York, NY by specialty
• Geriatric Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.