Healthcare Provider Details

I. General information

NPI: 1366561318
Provider Name (Legal Business Name): KARA BREZNAK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ERIE AVE
PHILADELPHIA PA
19134-1011
US

IV. Provider business mailing address

PO BOX 825366
PHILADELPHIA PA
19182-1011
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-3750
  • Fax:
Mailing address:
  • Phone: 484-628-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2008
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number010699
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058017
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: