Healthcare Provider Details

I. General information

NPI: 1508862889
Provider Name (Legal Business Name): LESLIE BREITEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 MAIN ST ONEONTA
ONEONTA NY
13820-2027
US

IV. Provider business mailing address

460 MAIN ST ONEONTA
ONEONTA NY
13820-2027
US

V. Phone/Fax

Practice location:
  • Phone: 607-433-0277
  • Fax: 607-432-1184
Mailing address:
  • Phone: 607-433-0277
  • Fax: 607-432-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number196604-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: