Healthcare Provider Details

I. General information

NPI: 1134121122
Provider Name (Legal Business Name): CAROL ANN BROWN-ALTUNA PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL STEINSIECK BROWN PNP

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1886 BROADWAY WEST PARK MEDICAL GROUP
NEW YORK NY
10023-7033
US

IV. Provider business mailing address

1886 BROADWAY
NEW YORK NY
10023-7033
US

V. Phone/Fax

Practice location:
  • Phone: 212-247-8100
  • Fax: 212-247-8093
Mailing address:
  • Phone: 212-247-8100
  • Fax: 212-247-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF380046 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: