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NPI Code Detail

MEDICARE: DR. TERESA L BREVETTI MD

MEDICARE: DR. TERESA L BREVETTI MD
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
1174400000XSpecialist215288-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17955259OTHERNYAETNA PPO ID #
220-0278746OTHERNYTAX ID #
3506A91OTHERNYEMPIRE BCBS OF NY ID #
40498091OTHERNYGHI PPO ID #
53622352OTHERNYAETNA HMO ID #
64C8738OTHERNYHEALTHNET ID #
7P3608471OTHERNYOXFORD ID #

General Provider Information

NPI Number : 1528056074
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERESA L BREVETTI MD
Provider Business Mailing Address
First Line : PO BOX 777
Second Line :
City : TENAFLY
State : NJ
Zip : 07670-0777
Country : US
Telephone Number : 718-616-3440
Fax Number :
Provider Business Practice Location Address
First Line : 2601 OCEAN PKWY
Second Line : CONEY ISLAND HOSPITAL DEPT OF SURGERY
City : BROOKLYN
State : NY
Zip : 11235-7745
Country : US
Telephone Number : 718-616-3440
Fax Number : 718-616-4436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 05/20/2015

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