Healthcare Provider Details

I. General information

NPI: 1295725570
Provider Name (Legal Business Name): RICHARD J BROWN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 FORKS RD
WEST WINFIELD NY
13491-1712
US

IV. Provider business mailing address

738 FORKS RD
WEST WINFIELD NY
13491-1712
US

V. Phone/Fax

Practice location:
  • Phone: 315-822-6646
  • Fax: 315-822-5407
Mailing address:
  • Phone: 315-822-6646
  • Fax: 315-822-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number125377-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: