Healthcare Provider Details

I. General information

NPI: 1134394323
Provider Name (Legal Business Name): NICOLE MARIE BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16318 JAMAICA AVE
JAMAICA NY
11432-4919
US

IV. Provider business mailing address

16318 JAMAICA AVE STE 2
JAMAICA NY
11432-4901
US

V. Phone/Fax

Practice location:
  • Phone: 718-450-9242
  • Fax: 646-905-0404
Mailing address:
  • Phone: 718-450-9242
  • Fax: 646-905-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number270554
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: