Provider Demographics
NPI:1629326756
Name:BROWN, JACQUELINE S
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:S
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16327 130TH AVE
Mailing Address - Street 2:APT 12D
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3001
Mailing Address - Country:US
Mailing Address - Phone:646-643-5444
Mailing Address - Fax:
Practice Address - Street 1:83 MARLBOROUGH RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4301
Practice Address - Country:US
Practice Address - Phone:718-284-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist