Healthcare Provider Details

I. General information

NPI: 1407773526
Provider Name (Legal Business Name): NYC MODERN GYNECOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 DR MARTIN L KING JR BLVD
BRONX NY
10453-6948
US

IV. Provider business mailing address

839 DUNCAN DR
WESTBURY NY
11590-1404
US

V. Phone/Fax

Practice location:
  • Phone: 718-294-3725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DESRENE BROWN
Title or Position: OWNER
Credential: MD
Phone: 419-721-4026