Individual
MR. MARK BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4865 BROADWAY APT 4W, NEW YORK, NY 10034-3104
(646) 410-0341
Mailing address
4865 BROADWAY APT 4W, NEW YORK, NY 10034-3104
(646) 410-0341
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
20159
NY
Other
Enumeration date
05/26/2009
Last updated
05/26/2009
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