Provider Demographics
NPI:1093910192
Name:TED BREZEL MD
Entity Type:Organization
Organization Name:TED BREZEL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:BREZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-418-3041
Mailing Address - Street 1:7959 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7451
Mailing Address - Country:US
Mailing Address - Phone:718-418-3041
Mailing Address - Fax:718-418-3115
Practice Address - Street 1:7959 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7451
Practice Address - Country:US
Practice Address - Phone:718-418-3041
Practice Address - Fax:718-418-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162847207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60874Medicare UPIN
NY03353Medicare ID - Type Unspecified