Provider Demographics
NPI:1053052233
Name:BREUTZMANN, AUTUMN (DO)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:BREUTZMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 YELLOWSTONE BLVD APT 4R
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2838
Mailing Address - Country:US
Mailing Address - Phone:623-221-7741
Mailing Address - Fax:
Practice Address - Street 1:401 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2244
Practice Address - Country:US
Practice Address - Phone:623-221-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program