Provider Demographics
NPI:1558676254
Name:BRAIN OWL TELEMEDICINE LLC
Entity Type:Organization
Organization Name:BRAIN OWL TELEMEDICINE LLC
Other - Org Name:BRAIN OWL TELEMEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANIV
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-238-5425
Mailing Address - Street 1:4801 S CONGRESS AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4746
Mailing Address - Country:US
Mailing Address - Phone:561-389-8424
Mailing Address - Fax:561-964-5835
Practice Address - Street 1:4801 S CONGRESS AVE STE 304
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4746
Practice Address - Country:US
Practice Address - Phone:561-389-8424
Practice Address - Fax:561-964-5835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1073272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty