Provider Demographics
NPI:1932593464
Name:BREILYN, MARGO SHECK (MD)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:SHECK
Last Name:BREILYN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:
Other - Last Name:SHECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3411 WAYNE AVE FL 9
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2552
Mailing Address - Country:US
Mailing Address - Phone:718-741-2323
Mailing Address - Fax:646-537-9405
Practice Address - Street 1:3411 WAYNE AVE FL 9
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2552
Practice Address - Country:US
Practice Address - Phone:718-741-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298960208000000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics