Provider Demographics
NPI:1174670996
Name:BROWNE, GILLIAN (PA)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:BROWNE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 34TH ST
Mailing Address - Street 2:APT. 4H
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-5164
Mailing Address - Country:US
Mailing Address - Phone:718-741-2470
Mailing Address - Fax:718-654-6692
Practice Address - Street 1:3415 BAINBRIDGE AVENUE
Practice Address - Street 2:CHAM
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-741-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant