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General NPI Number Information
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NPI Number | 1205486669
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Entity Type | Organization
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Legal Business Name | BREITBECK PHYSICIAN MEDICINE SERVICES, PC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 160 E MAIN ST
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City | PORT JERVIS
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State | NY
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Zip | 12771-2114
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Country | US
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Telephone | 845-858-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone | 800-893-9698
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | DR. BRUCE WHITMAN
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Credential | DO
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Telephone | 337-609-1221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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