Healthcare Provider Details

I. General information

NPI: 1649471608
Provider Name (Legal Business Name): KENNETH E BRESKY DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 ENTERPRISE CENTER BLVD SUITE 108
BOYNTON BEACH FL
33437-3759
US

IV. Provider business mailing address

10151 ENTERPRISE CENTER BLVD SUITE 108
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: KENNETH E. BRESKY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 561-740-4855