1528056074 NPI number — DR. TERESA L BREVETTI MD

Table of content: DR. TERESA L BREVETTI MD (NPI 1528056074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528056074 NPI number — DR. TERESA L BREVETTI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREVETTI
Provider First Name:
TERESA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528056074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 777
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TENAFLY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07670-0777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-616-3440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 OCEAN PKWY
Provider Second Line Business Practice Location Address:
CONEY ISLAND HOSPITAL DEPT OF SURGERY
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-7745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-616-3440
Provider Business Practice Location Address Fax Number:
718-616-4436
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  215288-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7955259 . This is a "AETNA PPO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 20-0278746 . This is a "TAX ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 506A91 . This is a "EMPIRE BCBS OF NY ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0498091 . This is a "GHI PPO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3622352 . This is a "AETNA HMO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C8738 . This is a "HEALTHNET ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3608471 . This is a "OXFORD ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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