Healthcare Provider Details

I. General information

NPI: 1255368452
Provider Name (Legal Business Name): KENNETH E. BRESKY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 ENTERPRISE CTR BOULEVARD, STE 100
BOYNTON BEACH FL
33437-3759
US

IV. Provider business mailing address

10151 ENTERPRISE CTR BOULEVARD, STE 100
BOYNTON BEACH FL
33437-3759
US

V. Phone/Fax

Practice location:
  • Phone: 561-740-4855
  • Fax: 561-740-4755
Mailing address:
  • Phone: 561-740-4855
  • Fax: 561-740-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberOS-7434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: