Provider Demographics
NPI:1285644344
Name:BREITMAN, DEBRA L (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
Last Name:BREITMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 ROCKAWAY TPKE STE 107
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1023
Mailing Address - Country:US
Mailing Address - Phone:516-239-7400
Mailing Address - Fax:516-400-9039
Practice Address - Street 1:135 ROCKAWAY TPKE STE 107
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1023
Practice Address - Country:US
Practice Address - Phone:516-239-7400
Practice Address - Fax:516-400-9039
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004366213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01130836Medicaid
NY1285644344Medicare UPIN
NYP46621Medicare PIN