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General NPI Number Information
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NPI Number | 1295725570
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Entity Type | Individual
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Provider Name | RICHARD J BROWN DO
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 754 FORKS RD
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City | WEST WINFIELD
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State | NY
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Zip | 13491-1712
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Country | US
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Telephone | 315-822-6646
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Fax | 315-822-5407
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Provider Business Mailing Address
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Address Line | 738 FORKS RD
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City | WEST WINFIELD
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State | NY
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Zip | 13491-1712
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Country | US
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Telephone | 315-822-6646
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Fax | 315-822-5407
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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 | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 125377-1
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License Number State | NY
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