Provider Demographics
NPI:1558384297
Name:BROWN, JEFFREY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:BROWN
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 1:100 MERRICK RD
Mailing Address - Street 2:SUITE 128 W
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4800
Mailing Address - Country:US
Mailing Address - Phone:516-255-9031
Mailing Address - Fax:516-255-6230
Practice Address - Street 1:100 MERRICK RD
Practice Address - Street 2:SUITE 128 W
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4800
Practice Address - Country:US
Practice Address - Phone:516-255-9031
Practice Address - Fax:516-255-6230
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149861-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02622553Medicaid
NYA15287Medicare UPIN
NY02622553Medicaid