Provider Demographics
NPI:1295877462
Name:BROWN, KIMBERLY FAHEY (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:FAHEY
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SANDS LIGHT RD
Mailing Address - Street 2:
Mailing Address - City:SANDS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1229
Mailing Address - Country:US
Mailing Address - Phone:516-767-3345
Mailing Address - Fax:516-767-3365
Practice Address - Street 1:450 PLANDOME RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1937
Practice Address - Country:US
Practice Address - Phone:516-627-6555
Practice Address - Fax:516-627-6651
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226784208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics