Provider Demographics
NPI:1467669523
Name:BROWN, EUGENE RULON III (LAC, CA, DOM)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:RULON
Last Name:BROWN
Suffix:III
Gender:M
Credentials:LAC, CA, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MANHATTAN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4234
Mailing Address - Country:US
Mailing Address - Phone:201-705-7442
Mailing Address - Fax:
Practice Address - Street 1:22 MADISON AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2734
Practice Address - Country:US
Practice Address - Phone:201-291-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00014900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist