Healthcare Provider Details

I. General information

NPI: 1003096157
Provider Name (Legal Business Name): BRAIN MATTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723 W ATLANTIC AVE # A-7
DELRAY BEACH FL
33445-3895
US

IV. Provider business mailing address

4723 WEST ATLANTIC AVE A-7
DELRAY BEACH FL
33445-3865
US

V. Phone/Fax

Practice location:
  • Phone: 561-374-8461
  • Fax: 561-374-8463
Mailing address:
  • Phone: 561-374-8461
  • Fax: 561-374-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME71236
License Number StateFL

VIII. Authorized Official

Name: MARK L BRODY
Title or Position: DOCTOR
Credential: MD
Phone: 561-374-8461