=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275255689
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KADINE BROWN AGACNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2022
-----------------------------------------------------
Last Update Date | 09/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26041 LANGSTON AVE
-----------------------------------------------------
City | GLEN OAKS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11004-1025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-784-0916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 E 77TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10075-1850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-434-2800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 432332
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------