Healthcare Provider Details

I. General information

NPI: 1033520168
Provider Name (Legal Business Name): LYDIA BROWN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22115 113TH DR
QUEENS VILLAGE NY
11429-2621
US

IV. Provider business mailing address

22115 113TH DR
QUEENS VILLAGE NY
11429-2621
US

V. Phone/Fax

Practice location:
  • Phone: 718-776-3381
  • Fax:
Mailing address:
  • Phone: 718-883-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338687
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22559567
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: