1912276437 NPI number — MR. TANYA TAWONE BROWN BA, CASAC

Table of content: MR. TANYA TAWONE BROWN BA, CASAC (NPI 1912276437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912276437 NPI number — MR. TANYA TAWONE BROWN BA, CASAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
TANYA
Provider Middle Name:
TAWONE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BA, CASAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARKS
Provider Other First Name:
TANYA
Provider Other Middle Name:
TAWONE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA,CASAC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912276437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 HATFIELD PL
Provider Second Line Business Mailing Address:
UPPER
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10302-2129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-226-2537
Provider Business Mailing Address Fax Number:
718-226-2998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 HATFIELD PL
Provider Second Line Business Practice Location Address:
UPPER
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-226-2537
Provider Business Practice Location Address Fax Number:
718-226-2998
Provider Enumeration Date:
12/29/2011

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: 101YP2500X , with the licence number:  20807 , 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)





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