Healthcare Provider Details

I. General information

NPI: 1972509420
Provider Name (Legal Business Name): ANDREA B BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CENTEROCK RD
WEST NYACK NY
10994-2215
US

IV. Provider business mailing address

PO BOX 411730
BOSTON MA
02241-1730
US

V. Phone/Fax

Practice location:
  • Phone: 845-703-6999
  • Fax: 845-703-6297
Mailing address:
  • Phone: 845-703-6999
  • Fax: 845-703-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number335508
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number052321
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: