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General NPI Number Information
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NPI Number | 1710138755
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Entity Type | Individual
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Provider Name | LISA BRESLOW DO
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Gender | Female
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 390 VINEYARD WAY BLDG 500 SUITE 501
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City | WEST GROVE
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State | PA
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Zip | 19390-8835
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Country | US
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Telephone | 610-869-0953
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Fax | 610-869-5824
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Provider Business Mailing Address
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Address Line | 390 VINEYARD WAY BLDG 500 SUITE 501
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City | WEST GROVE
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State | PA
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Zip | 19390-8835
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Country | US
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Telephone | 610-869-0953
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Fax | 610-869-5824
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101025286
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB10740100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 302800
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 032.0133896
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License Number State | VT
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S5130
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS018188
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License Number State | PA
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2020-00363
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License Number State | NC
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