MEDICARE: CAROL 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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1760918775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL BROWN

Provider Business Mailing Address
First Line	:	P.O. BOX 1005
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466
Country	:	US
Telephone Number	:	917-447-3661
Fax Number	:

Provider Business Practice Location Address
First Line	:	4245 ELY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2035
Country	:	US
Telephone Number	:	646-263-3974
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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Directions to “ CAROL BROWN ” Practice Location

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