Basic Information
| Provider Information | |||||||||
| NPI: | 1275943326 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | BENEDICT | ||||||||
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| NameSuffix: | III | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 416457 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022416457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 CENTRAL AVE STE 500 | ||||||||
| Address2: | |||||||||
| City: | NEW PROVIDENCE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079741505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087951192 | ||||||||
| FaxNumber: | 9087951193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2014 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 25MB10871400 | NJ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.