Provider Demographics
NPI:1134121122
Name:BROWN-ALTUNA, CAROL ANN (PNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:BROWN-ALTUNA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:STEINSIECK
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PNP
Mailing Address - Street 1:1886 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7033
Mailing Address - Country:US
Mailing Address - Phone:212-247-8100
Mailing Address - Fax:212-247-8093
Practice Address - Street 1:1886 BROADWAY
Practice Address - Street 2:WEST PARK MEDICAL GROUP
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7033
Practice Address - Country:US
Practice Address - Phone:212-247-8100
Practice Address - Fax:212-247-8093
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380046 1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
S63146Medicare UPIN
96V951Medicare ID - Type Unspecified