Provider Demographics
NPI:1467645663
Name:JEROME S. BRESLAW, M.D.,P.C.
Entity Type:Organization
Organization Name:JEROME S. BRESLAW, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRESLAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-628-5700
Mailing Address - Street 1:235 E 67TH ST
Mailing Address - Street 2:202
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 E 67TH ST
Practice Address - Street 2:202
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6040
Practice Address - Country:US
Practice Address - Phone:212-628-5700
Practice Address - Fax:212-650-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098889207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19908Medicare UPIN
NYWYRTT1Medicare PIN