Basic Information
| Provider Information | |||||||||
| NPI: | 1679704829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWNE | ||||||||
| FirstName: | JOLAN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2465 BROADWAY | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100257486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128772525 | ||||||||
| FaxNumber: | 2128775767 | ||||||||
| Practice Location | |||||||||
| Address1: | 2465 BROADWAY | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100257486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128772525 | ||||||||
| FaxNumber: | 2128775767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 09/01/2010 | ||||||||
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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 | 225100000X | PT020080 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 032964-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.