Provider Demographics
NPI:1316302979
Name:BROWN, BRIAN (PAC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2466 E CHESTNUT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8486
Mailing Address - Country:US
Mailing Address - Phone:856-691-2211
Mailing Address - Fax:
Practice Address - Street 1:2466 E CHESTNUT AVE STE 2
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8486
Practice Address - Country:US
Practice Address - Phone:856-691-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00RR5000208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine