Provider Demographics
NPI:1285662361
Name:BREEN, DAVID H (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:BREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3889 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454
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:585-335-2030
Practice Address - Fax:585-235-2035
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122238208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
105882DLOtherPFC
P010122238OtherBC
P020122238OtherBLS
00892439OtherMED
050607970OtherCHRMSCO
050607970OtherCHVA
33807OtherUCH 1
NY35667BOtherMEDICARE OLD PTAN INDIVIDUAOL
000526488003OtherBLSW
000526488003OtherCMB
33807OtherUHC 2
050607970OtherCHSTW
050607970OtherCIGNA
5265330OtherAETNA
000526488003OtherHNN
050607970OtherCHEMP
050607970OtherCHUNI
67043OtherFHN
P010122238OtherBCO
050607970OtherCIGNA
105882DLOtherPFC