Provider Demographics
NPI:1083647929
Name:BROWN-CAMERON, ELAINE SNOWBALL (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:SNOWBALL
Last Name:BROWN-CAMERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 OCEAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226
Mailing Address - Country:US
Mailing Address - Phone:718-668-5120
Mailing Address - Fax:908-226-9163
Practice Address - Street 1:941 OCEAN AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:718-668-5120
Practice Address - Fax:908-226-9163
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07856200207R00000X, 208000000X
NYNYS-227879207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2634595Medicaid
NJI23298Medicare UPIN
NY2634595Medicaid
064SRIMedicare UPIN