1497780746 NPI number — MR. JAMES W BRETON RPAC

Table of content: MR. JAMES W BRETON RPAC (NPI 1497780746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497780746 NPI number — MR. JAMES W BRETON RPAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRETON
Provider First Name:
JAMES
Provider Middle Name:
W
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPAC
Provider Gender Code:
M

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:
1497780746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 HAGEN DR
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14625-2658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-295-5314
Provider Business Mailing Address Fax Number:
585-248-2112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 HAGEN DR
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14625-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-295-5314
Provider Business Practice Location Address Fax Number:
585-248-2112
Provider Enumeration Date:
07/12/2006

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: 363A00000X , with the licence number:  7458 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0074581 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G0185663590 . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P019007458 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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