Provider Demographics
NPI:1770568560
Name:BREINGAN, PETER J (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:BREINGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:825 E GATE BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2124
Mailing Address - Country:US
Mailing Address - Phone:212-505-2151
Mailing Address - Fax:212-645-3165
Practice Address - Street 1:1355 NORTHERN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3023
Practice Address - Country:US
Practice Address - Phone:516-627-3232
Practice Address - Fax:516-365-1893
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2019-09-09
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Provider Licenses
StateLicense IDTaxonomies
NY208022207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061616047OtherTAX ID
48Z941Medicare ID - Type Unspecified
H26443Medicare UPIN