MEDICARE: PEREL BRODT

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	225100000X	Physical Therapist	020941-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356409205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEREL BRODT

Provider Business Mailing Address
First Line	:	3015 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 EAST 17 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230
Country	:	US
Telephone Number	:	718-434-4600
Fax Number	:	712-434-6261

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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Directions to “ PEREL BRODT ” Practice Location

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