Provider Demographics
NPI:1063658797
Name:BRESLAU, VLADIMIR F (DO, PHD)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:F
Last Name:BRESLAU
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:VLADIMIR
Other - Middle Name:F
Other - Last Name:BRESLAOUKHOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO, PHD
Mailing Address - Street 1:179 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1019
Mailing Address - Country:US
Mailing Address - Phone:607-337-4218
Mailing Address - Fax:607-337-4064
Practice Address - Street 1:179 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1019
Practice Address - Country:US
Practice Address - Phone:607-337-4218
Practice Address - Fax:607-337-4064
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251018207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME208509Medicare PIN