Provider Demographics
NPI:1447771423
Name:BREEST, ALEXIS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BREEST
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 HART AVE
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NY
Mailing Address - Zip Code:11901-4013
Mailing Address - Country:US
Mailing Address - Phone:631-833-5215
Mailing Address - Fax:
Practice Address - Street 1:1300 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2031
Practice Address - Country:US
Practice Address - Phone:631-833-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant