1265549414 NPI number — DR. PAUL ROBERT BROWN DPM

Table of content: DR. PAUL ROBERT BROWN DPM (NPI 1265549414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265549414 NPI number — DR. PAUL ROBERT BROWN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
PAUL
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1265549414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
290 MADISON AVE
Provider Second Line Business Mailing Address:
SUITE 3A
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07960-7400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-998-8900
Provider Business Mailing Address Fax Number:
973-998-8902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-7400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-998-8900
Provider Business Practice Location Address Fax Number:
973-998-8902
Provider Enumeration Date:
08/24/2006

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: 213E00000X , with the licence number:  25MD00158300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2017709 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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