Provider Demographics
NPI:1447221437
Name:BREIDBART, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BREIDBART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6 OHIO DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1129
Mailing Address - Country:US
Mailing Address - Phone:516-328-8700
Mailing Address - Fax:516-328-8779
Practice Address - Street 1:6 OHIO DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1129
Practice Address - Country:US
Practice Address - Phone:516-328-8700
Practice Address - Fax:516-328-8779
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY142695207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB14320Medicare UPIN
NY41D511Medicare ID - Type Unspecified