Healthcare Provider Details

I. General information

NPI: 1336277458
Provider Name (Legal Business Name): HOWARD NEIL BROOKS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 ARCH ST
PHILADELPHIA PA
19107-3002
US

IV. Provider business mailing address

1500 MARKET ST 24TH FLOOR-WEST TOWER
PHILADELPHIA PA
19102-2100
US

V. Phone/Fax

Practice location:
  • Phone: 215-268-7755
  • Fax: 215-627-2985
Mailing address:
  • Phone: 215-255-3828
  • Fax: 215-255-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS001841L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: