Healthcare Provider Details

I. General information

NPI: 1336757277
Provider Name (Legal Business Name): CHLOE IVY BROWN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DUANE ST
NEW YORK NY
10007-1126
US

IV. Provider business mailing address

110 DUANE ST
NEW YORK NY
10007-1126
US

V. Phone/Fax

Practice location:
  • Phone: 212-588-1919
  • Fax: 877-992-0798
Mailing address:
  • Phone: 212-588-1919
  • Fax: 877-992-0798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number025230
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: