Healthcare Provider Details

I. General information

NPI: 1700799210
Provider Name (Legal Business Name): NICHOLAS J BROWN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

161 RICHMOND BLVD
RONKONKOMA NY
11779-3664
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-8333
  • Fax:
Mailing address:
  • Phone: 631-680-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number012885
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: