Provider Demographics
NPI:1720386709
Name:BROWN, ADAM LOUIS (LAC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:LOUIS
Last Name:BROWN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W END AVE
Mailing Address - Street 2:11C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5370
Mailing Address - Country:US
Mailing Address - Phone:212-366-9025
Mailing Address - Fax:212-663-9026
Practice Address - Street 1:817 W END AVE
Practice Address - Street 2:11C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5370
Practice Address - Country:US
Practice Address - Phone:212-366-9025
Practice Address - Fax:212-663-9026
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001792171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist