MEDICARE: MR. BENJAMIN J BRODY HAS, BC-HIS

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	237700000X	Hearing Instrument Specialist	AS3492	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6373	OTHER	FL	NATIONAL BOARD FOR CERTIFICATION IN HEARING INSTRUMENT SCIENCES
2	AS3492	OTHER	FL	FLORIDA DEPARTMENT OF HEALTH, DIVISION OF MEDICAL QUALITY ASSURANCE

General Provider Information

NPI Number	:	1164770061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN J BRODY HAS, BC-HIS

Provider Business Mailing Address
First Line	:	2981 N NOB HILL RD APT 207
Second Line	:	207
City	:	SUNRISE
State	:	FL
Zip	:	33322-5889
Country	:	US
Telephone Number	:	954-908-5208
Fax Number	:

Provider Business Practice Location Address
First Line	:	2981 N NOB HILL RD APT 207
Second Line	:	207
City	:	SUNRISE
State	:	FL
Zip	:	33322-5889
Country	:	US
Telephone Number	:	954-908-5208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	09/18/2016

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