Provider Demographics
NPI:1962027078
Name:GREGORY R BREVETTI, M.D, PC.
Entity Type:Organization
Organization Name:GREGORY R BREVETTI, M.D, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-584-8903
Mailing Address - Street 1:8318 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4413
Mailing Address - Country:US
Mailing Address - Phone:718-748-0500
Mailing Address - Fax:
Practice Address - Street 1:8318 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4413
Practice Address - Country:US
Practice Address - Phone:718-748-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1619954435OtherINDIVIDUAL NPI NUMBER