Healthcare Provider Details

I. General information

NPI: 1255964268
Provider Name (Legal Business Name): CASEY BROWN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 12/02/2025
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E FAIRMOUNT AVE
LAKEWOOD NY
14750-2000
US

IV. Provider business mailing address

305 E FAIRMOUNT AVE
LAKEWOOD NY
14750-2000
US

V. Phone/Fax

Practice location:
  • Phone: 716-526-4041
  • Fax:
Mailing address:
  • Phone: 716-526-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402915
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: