Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Rose Johnson

Individual provider Surgery Physician · NPI 1427410281

Kelly Rose Johnson is a Surgical Oncology in Bronx, New York. Graduated from Philadelphia College of Osteopathic Medicine in 2016, 10 years ago. Practices with Stony Brook Surgical Associates University Faculty Practice Corporati, a 102-clinician group and accepts Medicare assignment. Licensed in New York and Pennsylvania.

Years since qualifying
10
Trained at
Philadelphia College of Osteopathic Medicine
Licensed in
NY, PA
In the registry since
2016
Specialties on file
3
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Practice location Address checks out

1521 Jarret Pl
Bronx, NY 10461-2606
Phone: (718) 862-8840
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence 310107-01 (NY)
Surgery Physician Taxonomy 208600000X · Licence OT017016 (PA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1427410281
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 22, 2016
Last updated in NPPESApril 23, 2022
Certification dateApril 23, 2022
Mailing address206 Brooksite Dr, Smithtown, NY 11787-4443

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtySURGICAL ONCOLOGY
Medical schoolPHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
Graduated 2016 (10 years in practice)
Group practice Stony Brook Surgical Associates University Faculty Practice Corporati — 102 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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