Provider Demographics
NPI:1245290881
Name:BREITMAN, CINDY L (PHD)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:L
Last Name:BREITMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CINDY
Other - Middle Name:L
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1430 BROADWAY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-3308
Mailing Address - Country:US
Mailing Address - Phone:212-840-8410
Mailing Address - Fax:212-840-8415
Practice Address - Street 1:1430 BROADWAY
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3308
Practice Address - Country:US
Practice Address - Phone:212-840-8410
Practice Address - Fax:212-840-8415
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014513103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02511695Medicaid
NYP2577625OtherOXFORD
NY02511695Medicaid