Provider Demographics
NPI:1013276369
Name:BROWN, RANDOLPH K (LAC)
Entity Type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:K
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 1:336 RIVERSIDE DR APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3498
Mailing Address - Country:US
Mailing Address - Phone:212-866-6316
Mailing Address - Fax:
Practice Address - Street 1:336 RIVERSIDE DR APT 4A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3498
Practice Address - Country:US
Practice Address - Phone:212-866-6316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000930-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist