Healthcare Provider Details

I. General information

NPI: 1932593464
Provider Name (Legal Business Name): MARGO SHECK BREILYN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGO SHECK MD

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 WAYNE AVE FL 9
BRONX NY
10467-2552
US

IV. Provider business mailing address

3411 WAYNE AVE FL 9
BRONX NY
10467-2552
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2323
  • Fax:
Mailing address:
  • Phone: 718-741-2323
  • Fax: 646-537-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number298960
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number298960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: