Basic Information
| Provider Information | |||||||||
| NPI: | 1285642959 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | EVLYN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 592 ROCKAWAY AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112125539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183455000 | ||||||||
| FaxNumber: | 7183455794 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 SNEDIKER AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112074552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6464599400 | ||||||||
| FaxNumber: | 6464599455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 02/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME117067 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2009-01964 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 226326 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02410295 | 05 | NY | MEDICAID | 5914336 | 05 | NC | MEDICAID | 010394500 | 05 | FL | MEDICAID | 14T22 | 01 | FL | FLORIDA BLUE | OTHER |