Basic Information
| Provider Information | |||||||||
| NPI: | 1255757720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN BRYAN | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | JANICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 E 38TH ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100162772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465017300 | ||||||||
| FaxNumber: | 6467549512 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 E 38TH ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100162772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465017300 | ||||||||
| FaxNumber: | 6467549512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2014 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 306798 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.