Healthcare Provider Details

I. General information

NPI: 1598294357
Provider Name (Legal Business Name): NATHANIEL BROWN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TREMONT ST
ROCHESTER NY
14608-2393
US

IV. Provider business mailing address

215 TREMONT ST
ROCHESTER NY
14608-2393
US

V. Phone/Fax

Practice location:
  • Phone: 585-201-4914
  • Fax: 585-280-5285
Mailing address:
  • Phone: 585-201-4914
  • Fax: 585-280-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: