Provider Demographics
NPI:1538119961
Name:BREEN, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
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 1:52 W RED BANK AVE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1695
Mailing Address - Country:US
Mailing Address - Phone:856-853-2025
Mailing Address - Fax:856-845-8024
Practice Address - Street 1:52 W RED BANK AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1695
Practice Address - Country:US
Practice Address - Phone:856-853-2025
Practice Address - Fax:856-845-8024
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07250600207RC0200X, 207RP1001X, 207RS0012X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0025968Medicaid
NJ049233Medicare Oscar/Certification
G61508Medicare UPIN
G61508Medicare UPIN
PA953129FDGMedicare ID - Type Unspecified