Provider Demographics
NPI:1164770061
Name:BRODY, BENJAMIN J (HAS, BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:J
Last Name:BRODY
Suffix:
Gender:M
Credentials:HAS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2981 N NOB HILL RD APT 207
Mailing Address - Street 2:207
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5889
Mailing Address - Country:US
Mailing Address - Phone:954-908-5208
Mailing Address - Fax:
Practice Address - Street 1:2981 N NOB HILL RD APT 207
Practice Address - Street 2:207
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-5889
Practice Address - Country:US
Practice Address - Phone:954-908-5208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3492237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6373OtherNATIONAL BOARD FOR CERTIFICATION IN HEARING INSTRUMENT SCIENCES
FLAS3492OtherFLORIDA DEPARTMENT OF HEALTH, DIVISION OF MEDICAL QUALITY ASSURANCE