Provider Demographics
NPI:1093692295
Name:BROWN, ETHAN (MB BCH BAO)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E 81ST ST APT 6J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7031
Mailing Address - Country:US
Mailing Address - Phone:646-295-2343
Mailing Address - Fax:
Practice Address - Street 1:504 E 81ST ST APT 6J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7031
Practice Address - Country:US
Practice Address - Phone:646-295-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3349342085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging