Provider Demographics
NPI:1801850680
Name:BREZLER, MARIO ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ROBERTO
Last Name:BREZLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 OVERLOOK RD
Mailing Address - Street 2:APT 3 A 6
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2442
Mailing Address - Country:US
Mailing Address - Phone:845-893-1053
Mailing Address - Fax:815-550-2166
Practice Address - Street 1:2 OVERLOOK RD
Practice Address - Street 2:APT 3 A 6
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2442
Practice Address - Country:US
Practice Address - Phone:845-893-1053
Practice Address - Fax:815-550-2166
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY115845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A74895OtherUPIN