Healthcare Provider Details

I. General information

NPI: 1881525491
Provider Name (Legal Business Name): MR. JONATHAN MAURICE BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MORGAN LN
ONEIDA NY
13421-1840
US

IV. Provider business mailing address

115 MORGAN LN
ONEIDA NY
13421-1840
US

V. Phone/Fax

Practice location:
  • Phone: 315-335-4056
  • Fax:
Mailing address:
  • Phone: 315-335-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130983-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: