Provider Demographics
NPI:1306224415
Name:BROWN, ANTANIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ANTANIQUE
Middle Name:
Last Name:BROWN
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 1:408 S 10TH AVE APT M4
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-3021
Mailing Address - Country:US
Mailing Address - Phone:908-251-0023
Mailing Address - Fax:
Practice Address - Street 1:100 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8480
Practice Address - Country:US
Practice Address - Phone:631-444-2968
Practice Address - Fax:631-444-2907
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA1053970207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program