MEDICARE: DR. GARY B BREITBART M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	25MA03993700	NJ
2	208600000X	Surgery Physician	25MA03993700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1028839	OTHER	NJ	CIGNA
2	1340660	OTHER	NJ	UNITED HEALTHCARE
3	0280166000	OTHER	NJ	AMERIHEALTH
4	2292111	OTHER	NJ	AETNA
5	ES137	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1073553400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY B BREITBART M.D.

Provider Business Mailing Address
First Line	:	1511 PARK AVE
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-5516
Country	:	US
Telephone Number	:	908-561-9500
Fax Number	:	908-561-7162

Provider Business Practice Location Address
First Line	:	1511 PARK AVE
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-5516
Country	:	US
Telephone Number	:	908-561-9500
Fax Number	:	908-561-7162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	06/24/2015

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Directions to “ DR. GARY B BREITBART M.D.” Practice Location

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