Healthcare Provider Details

I. General information

NPI: 1144248071
Provider Name (Legal Business Name): ALISA GLADSTONE-BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 HENRY HUDSON PKWY E
BRONX NY
10471-3216
US

IV. Provider business mailing address

5020 HENRY HUDSON PKWY E
BRONX NY
10471-3216
US

V. Phone/Fax

Practice location:
  • Phone: 917-519-9401
  • Fax:
Mailing address:
  • Phone: 917-519-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number198210
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number198210
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: