MEDICARE: BRAIN MATTERS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	ME71236	FL

General Provider Information

NPI Number	:	1003096157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN MATTERS INC

Provider Business Mailing Address
First Line	:	4723 WEST ATLANTIC AVE A-7
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3865
Country	:	US
Telephone Number	:	561-374-8461
Fax Number	:	561-374-8463

Provider Business Practice Location Address
First Line	:	4723 W ATLANTIC AVE # A-7
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3895
Country	:	US
Telephone Number	:	561-374-8461
Fax Number	:	561-374-8463

Authorized Official
Title or Position	:	DOCTOR
Name	:	MARK L BRODY
Credential	:	MD
Telephone Number	:	561-374-8461

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	07/02/2008

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