Healthcare Provider Details

I. General information

NPI: 1083675037
Provider Name (Legal Business Name): PAUL M BREUER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 FT WASHINGTON AVE
NEW YORK NY
10033-4626
US

IV. Provider business mailing address

495 FT WASHINGTON AVE
NEW YORK NY
10033-4626
US

V. Phone/Fax

Practice location:
  • Phone: 212-928-1171
  • Fax: 212-543-0666
Mailing address:
  • Phone: 212-928-1171
  • Fax: 212-543-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV0029971
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: