=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083857585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY STEPHANIE BROWN MD, MBE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2009
-----------------------------------------------------
Last Update Date | 09/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 630 W 168TH ST CHN5-517
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-3725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-8504
-----------------------------------------------------
Fax | 212-305-8881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3959 BROADWAY CHC 7-737
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-5122
-----------------------------------------------------
Fax | 212-305-6103
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0214X
-----------------------------------------------------
Taxonomy Name | Pediatric Pulmonology Physician
-----------------------------------------------------
License Number | 260130
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------