Healthcare Provider Details

I. General information

NPI: 1215833405
Provider Name (Legal Business Name): GABRIELLE NICOLE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2026
Last Update Date: 10/15/2026
Certification Date: 10/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 NEWTOWN RD STE 102
PLAINVIEW NY
11803-4317
US

IV. Provider business mailing address

225 LINCOLN AVE
BRENTWOOD NY
11717-2250
US

V. Phone/Fax

Practice location:
  • Phone: 516-802-2518
  • Fax: 516-644-5471
Mailing address:
  • Phone: 631-339-4758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number031502
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: