1558315440 NPI number — MICHAEL BROWN DO

Table of content: MICHAEL BROWN DO (NPI 1558315440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558315440 NPI number — MICHAEL BROWN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558315440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 PROSPECT AVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-2907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-2566
Provider Business Mailing Address Fax Number:
518-697-3403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 PROSPECT AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-2566
Provider Business Practice Location Address Fax Number:
518-697-3403
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  1-113905 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000492901001 . This is a "BS OF NENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00770392 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050210000044 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10025345 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2597780 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43082 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 217331 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 92A713 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1891975 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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