MEDICARE: HEALTHSOURCE OF BROOKLYN

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
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1689825754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHSOURCE OF BROOKLYN

Provider Business Mailing Address
First Line	:	PO BOX 740
Second Line	:
City	:	VERMILION
State	:	OH
Zip	:	44089-0740
Country	:	US
Telephone Number	:	440-967-4226
Fax Number	:	440-967-0296

Provider Business Practice Location Address
First Line	:	4370 RIDGE RD
Second Line	:
City	:	BROOKLYN
State	:	OH
Zip	:	44144-2717
Country	:	US
Telephone Number	:	440-967-4226
Fax Number	:	440-967-0296

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAZIAR NEJAD
Credential	:	D.C.
Telephone Number	:	440-967-4226

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/07/2008

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Directions to “HEALTHSOURCE OF BROOKLYN ” Practice Location

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