Basic Information
Provider Information
NPI: 1275507014
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: ROY
MiddleName: EDWARD
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 288 E MOUNTAIN RD
Address2:  
City: COLDSPRING
State: NC
PostalCode: 10516
CountryCode: US
TelephoneNumber: 2123047250
FaxNumber:  
Practice Location
Address1: COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS
Address2: 3959 BROADWAY
City: NEW YORK
State: NY
PostalCode: 10032
CountryCode: US
TelephoneNumber: 2123047297
FaxNumber: 2125441974
Other Information
ProviderEnumerationDate: 02/16/2006
LastUpdateDate: 10/27/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X798091NYY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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