Provider Demographics
NPI:1043261944
Name:BRESLAU, LEWIS (AUD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:BRESLAU
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:LEWIS
Other - Middle Name:
Other - Last Name:BRESLAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:176 N VILLAGE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3800
Mailing Address - Country:US
Mailing Address - Phone:516-221-2390
Mailing Address - Fax:516-221-2395
Practice Address - Street 1:176 N VILLAGE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3800
Practice Address - Country:US
Practice Address - Phone:516-678-1804
Practice Address - Fax:516-678-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0009661231H00000X, 237600000X
NY14000002408237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100189235701OtherAMERICHOICE
NY1892357OtherUNITED HEALTHCARE
NY0036041OtherGHI
NY19697POtherHIP
NY500021OtherAETNA NUMBER
8461006002OtherCIGNA
NY112920413OtherTAX ID
NYDS155OtherOXFORD
NY19697POtherHIP
NY500021OtherAETNA NUMBER
NY36041GMedicare ID - Type UnspecifiedMEDICARE NUMBER
NY0036041OtherGHI