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General NPI Number Information
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NPI Number | 1134449572
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Entity Type | Individual
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Provider Name | RANDOLPH BREWLEY
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Gender | Male
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 445 PARK AVE 9TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10022-2606
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Country | US
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Telephone | 347-856-8396
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 110135
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City | CAMBRIA HEIGHTS
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State | NY
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Zip | 11411-0135
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Country | US
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Telephone |
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 299844
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License Number State | NY
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