Provider Demographics
NPI:1093994832
Name:DAVID H. BREEN MD PLLC
Entity Type:Organization
Organization Name:DAVID H. BREEN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:BREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-243-4000
Mailing Address - Street 1:3889 NORTH ROAD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9745
Mailing Address - Country:US
Mailing Address - Phone:585-243-4000
Mailing Address - Fax:585-243-4002
Practice Address - Street 1:36 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-1632
Practice Address - Country:US
Practice Address - Phone:585-243-4000
Practice Address - Fax:585-243-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122238207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00892439Medicaid
NYY28353Medicare UPIN
NY00892439Medicaid