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General NPI Number Information
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NPI Number | 1083153472
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Entity Type | Individual
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Provider Name | DORETHA CLARA BROWN-SIMPSON ED. D.
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Gender | Female
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 22424 144TH AVE
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-3501
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Country | US
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Telephone | 917-854-3290
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Fax | 718-341-0005
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Provider Business Mailing Address
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Address Line | 224-24 144 AVENUE
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-3501
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Country | US
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Telephone | 917-854-3290
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Fax | 718-341-0005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 195920021
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License Number State | NY
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