Provider Demographics
NPI:1689825754
Name:HEALTHSOURCE OF BROOKLYN
Entity Type:Organization
Organization Name:HEALTHSOURCE OF BROOKLYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-967-4226
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-0740
Mailing Address - Country:US
Mailing Address - Phone:440-967-4226
Mailing Address - Fax:440-967-0296
Practice Address - Street 1:4370 RIDGE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-2717
Practice Address - Country:US
Practice Address - Phone:440-967-4226
Practice Address - Fax:440-967-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty