Provider Demographics
NPI:1811558000
Name:BROWN, FRED HENRY III (RRT)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:HENRY
Last Name:BROWN
Suffix:III
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2043
Mailing Address - Country:US
Mailing Address - Phone:516-541-2633
Mailing Address - Fax:
Practice Address - Street 1:89 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2043
Practice Address - Country:US
Practice Address - Phone:516-541-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004041227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered