Provider Demographics
NPI:1831106053
Name:BRESLAW, JEROME SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:SAMUEL
Last Name:BRESLAW
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 1:232 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8202
Mailing Address - Country:US
Mailing Address - Phone:212-889-5544
Mailing Address - Fax:212-481-1089
Practice Address - Street 1:232 E 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8202
Practice Address - Country:US
Practice Address - Phone:212-889-5544
Practice Address - Fax:212-481-1089
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098889207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology