Provider Demographics
NPI:1023259074
Name:BRESLOW MEDICAL PC
Entity type:Organization
Organization Name:BRESLOW MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRESLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-834-5069
Mailing Address - Street 1:2754 CONEY ISLAND AVE STE 56
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5016
Mailing Address - Country:US
Mailing Address - Phone:347-834-5069
Mailing Address - Fax:877-219-1596
Practice Address - Street 1:2754 CONEY ISLAND AVE STE 56
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5016
Practice Address - Country:US
Practice Address - Phone:347-834-5069
Practice Address - Fax:877-219-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228436208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty