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NPI Code Detail

MEDICARE: MR. TYLER BROWN

MEDICARE: MR. TYLER BROWN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantNY
2390200000XStudent in an Organized Health Care Education/Training Program
3363AS0400XSurgical Physician Assistant026974NY

General Provider Information

NPI Number : 1134758568
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TYLER BROWN
Provider Business Mailing Address
First Line : 570 LEXINGTON AVE FL 9
Second Line :
City : NEW YORK
State : NY
Zip : 10022-6710
Country : US
Telephone Number : 646-962-7277
Fax Number :
Provider Business Practice Location Address
First Line : 570 LEXINGTON AVE FL 9
Second Line :
City : NEW YORK
State : NY
Zip : 10022-6710
Country : US
Telephone Number : 646-962-7277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2020
Last Update Date : 08/06/2021

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