Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 125377-1 | NY |
NPI | 1295725570 |
---|---|
Provider Name | Dr. Richard J Brown |
First Address | West Winfield, NY 13491-1712 |
Second Address | West Winfield, NY 13491-1712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 23/08/2010 |