Provider Demographics
NPI:1518921956
Name:BROWN, WILLIAM TED (MD, PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TED
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 FOREST HILL RD
Mailing Address - Street 2:NYS INSTITUTE FOR BASIC RESEARCH
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-494-5117
Mailing Address - Fax:718-494-2258
Practice Address - Street 1:1050 FOREST HILL RD
Practice Address - Street 2:NYS INSTITUTE FOR BASIC RESEARCH
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-494-5117
Practice Address - Fax:718-494-2258
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124025207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7110906OtherAETNA
NY359774OtherUNITED HEALTHCARE
NYP3654928OtherOXFORD
NY4300010OtherCIGNA
NY2517073OtherGHI
NY01134041Medicaid
NY223700POtherHIP
NY7110906OtherAETNA
NY359774OtherUNITED HEALTHCARE