Healthcare Provider Details

I. General information

NPI: 1902360613
Provider Name (Legal Business Name): TARIF A BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2019
Last Update Date: 01/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MELROSE AVE
BRONX NY
10451-4443
US

IV. Provider business mailing address

1 LARKIN PLZ APT 903
YONKERS NY
10701-2877
US

V. Phone/Fax

Practice location:
  • Phone: 917-473-6996
  • Fax:
Mailing address:
  • Phone: 240-855-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: