Healthcare Provider Details

I. General information

NPI: 1285642959
Provider Name (Legal Business Name): EVLYN BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SNEDIKER AVE
BROOKLYN NY
11207-4552
US

IV. Provider business mailing address

592 ROCKAWAY AVE
BROOKLYN NY
11212-5539
US

V. Phone/Fax

Practice location:
  • Phone: 646-459-9400
  • Fax: 646-459-9455
Mailing address:
  • Phone: 718-345-5000
  • Fax: 718-345-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME117067
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2009-01964
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number226326
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: