Provider Demographics
NPI:1427026103
Name:BREEN, MARTIN J (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
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 1:154 WARREN ST
Mailing Address - Street 2:PO BOX 141
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-798-9985
Mailing Address - Fax:518-761-7043
Practice Address - Street 1:154 WARREN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-798-9985
Practice Address - Fax:518-761-7043
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230499208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02501031Medicaid