Healthcare Provider Details

I. General information

NPI: 1164506721
Provider Name (Legal Business Name): REBECCA C BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GRAND AVE FIRST FLOOR
ENGLEWOOD NJ
07631-4967
US

IV. Provider business mailing address

500 GRAND AVE FIRST FLOOR
ENGLEWOOD NJ
07631-4967
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-2277
  • Fax: 201-567-2639
Mailing address:
  • Phone: 201-567-2277
  • Fax: 201-567-2639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number235399
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: