Healthcare Provider Details

I. General information

NPI: 1346756772
Provider Name (Legal Business Name): JASON BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 E 71ST ST FL 4
NEW YORK NY
10021-4892
US

IV. Provider business mailing address

418 E 71ST ST FL 4
NEW YORK NY
10021-4892
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-8932
  • Fax: 212-535-5443
Mailing address:
  • Phone: 212-535-8932
  • Fax: 212-535-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number107557
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number107577-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: