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General NPI Number Information
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NPI Number | 1558676254
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Entity Type | Organization
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Legal Business Name | BRAIN OWL TELEMEDICINE LLC
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 4801 S CONGRESS AVE STE 304
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City | LAKE WORTH
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State | FL
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Zip | 33461-4746
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Country | US
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Telephone | 561-389-8424
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Fax | 561-964-5835
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Provider Business Mailing Address
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Address Line | 4801 S CONGRESS AVE STE 304
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City | LAKE WORTH
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State | FL
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Zip | 33461-4746
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Country | US
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Telephone | 561-389-8424
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Fax | 561-964-5835
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | DR. YANIV CHEN
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Credential | M.D.
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Telephone | 917-238-5425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME107327
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License Number State | FL
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