Provider Demographics
NPI:1699883306
Name:BROWN, MITCHELL LEE (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:758 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3948
Mailing Address - Country:US
Mailing Address - Phone:201-339-2220
Mailing Address - Fax:201-339-3667
Practice Address - Street 1:758 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3948
Practice Address - Country:US
Practice Address - Phone:201-339-2220
Practice Address - Fax:201-339-3667
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05662800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110060995OtherRR MEDICARE
NJ1699883306Medicare PIN
NJ110060995OtherRR MEDICARE