Provider Demographics
NPI:1235227190
Name:GREY-BROOKS, VIXEN LEIGHTON-ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:VIXEN
Middle Name:LEIGHTON-ANDREW
Last Name:GREY-BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E 105TH ST, APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:917-755-3954
Mailing Address - Fax:954-337-0565
Practice Address - Street 1:14 E 105TH ST APT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4410
Practice Address - Country:US
Practice Address - Phone:917-355-3879
Practice Address - Fax:954-337-0565
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2211912084P0804X, 208000000X, 2084P0800X
FLME1075792084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002817700Medicaid
FL002817700Medicaid
NY484X11Medicare ID - Type Unspecified