MEDICARE: DR. SAMUEL PEARCE BROWN D.O.

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
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	279703	NY

General Provider Information

NPI Number	:	1275848970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL PEARCE BROWN D.O.

Provider Business Mailing Address
First Line	:	700 BOISSEAU AVE
Second Line	:
City	:	SOUTHOLD
State	:	NY
Zip	:	11971-2926
Country	:	US
Telephone Number	:	631-477-5353
Fax Number	:	631-477-5891

Provider Business Practice Location Address
First Line	:	700 BOISSEAU AVE
Second Line	:
City	:	SOUTHOLD
State	:	NY
Zip	:	11971-2926
Country	:	US
Telephone Number	:	631-477-5353
Fax Number	:	631-477-5891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	10/30/2024

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