Healthcare Provider Details

I. General information

NPI: 1235242124
Provider Name (Legal Business Name): JAMIN S. BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GREENFIELD PKWY
LIVERPOOL NY
13088-6655
US

IV. Provider business mailing address

200 GREENFIELD PKWY
LIVERPOOL NY
13088-6655
US

V. Phone/Fax

Practice location:
  • Phone: 315-445-8166
  • Fax: 315-445-2697
Mailing address:
  • Phone: 315-445-8179
  • Fax: 315-251-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberML20008129
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number256631
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number256631
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: