MEDICARE: DR. EVAN BRETH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	N005657	NY
2	213ES0131X	Foot Surgery Podiatrist	N005657	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023097052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN BRETH DPM

Provider Business Mailing Address
First Line	:	2352 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5515
Country	:	US
Telephone Number	:	718-251-0200
Fax Number	:	718-209-5697

Provider Business Practice Location Address
First Line	:	2352 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5515
Country	:	US
Telephone Number	:	718-251-0200
Fax Number	:	718-209-5697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	11/17/2008

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Directions to “ DR. EVAN BRETH DPM” Practice Location

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