Basic Information
| Provider Information | |||||||||
| NPI: | 1023042348 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOC BROWNS INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MID ISLAND MEDICAL SUPPLY COMPANY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2093 WANTAGH AVE | ||||||||
| Address2: | |||||||||
| City: | WANTAGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117933913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167817332 | ||||||||
| FaxNumber: | 5167812542 | ||||||||
| Practice Location | |||||||||
| Address1: | 2093 WANTAGH AVE | ||||||||
| Address2: | |||||||||
| City: | WANTAGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117933913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167817332 | ||||||||
| FaxNumber: | 5167812542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 03/24/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5167817332 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition |
ID Information
| ID | Type | State | Issuer | Description | F394358 | 01 | CT | OXFORD | OTHER | 1535046 | 01 | GA | UNITED HEALTHCARE | OTHER | 100153504601 | 01 | GA | AMERICHOICE | OTHER | 01577384 | 05 | NY | MEDICAID |