MEDICARE: JASON R BROWN LMT

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	225700000X	Massage Therapist	019171-1	NY

General Provider Information

NPI Number	:	1245847078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON R BROWN LMT

Provider Business Mailing Address
First Line	:	5545 NETHERLAND AVE APT 4E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-2339
Country	:	US
Telephone Number	:	646-496-5526
Fax Number	:

Provider Business Practice Location Address
First Line	:	5545 NETHERLAND AVE APT 4E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-2339
Country	:	US
Telephone Number	:	646-496-5526
Fax Number	:

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

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	09/25/2020

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