Provider Demographics
NPI:1083972764
Name:LESLIE BREITEN, M.D.
Entity Type:Organization
Organization Name:LESLIE BREITEN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BREITEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-433-0277
Mailing Address - Street 1:460 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2027
Mailing Address - Country:US
Mailing Address - Phone:607-433-0277
Mailing Address - Fax:607-432-1184
Practice Address - Street 1:460 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2027
Practice Address - Country:US
Practice Address - Phone:607-433-0277
Practice Address - Fax:607-432-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1966041207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0125Medicare PIN