Provider Demographics
NPI:1316924251
Name:BROWN, KEVIN S (PA)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:S
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:776 SHREWSBURY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3006
Mailing Address - Country:US
Mailing Address - Phone:732-530-4949
Mailing Address - Fax:732-212-1171
Practice Address - Street 1:776 SHREWSBURY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3006
Practice Address - Country:US
Practice Address - Phone:732-530-4949
Practice Address - Fax:732-530-3618
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMP00777363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222606262OtherHORIZON BCBS
NJ0000405555Medicare ID - Type UnspecifiedMEDICARE GRP#
NJ222606262OtherHORIZON BCBS
NJ053778AYKMedicare ID - Type UnspecifiedMEDICARE