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
1	174400000X	Specialist	215288-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7955259	OTHER	NY	AETNA PPO ID #
2	20-0278746	OTHER	NY	TAX ID #
3	506A91	OTHER	NY	EMPIRE BCBS OF NY ID #
4	0498091	OTHER	NY	GHI PPO ID #
5	3622352	OTHER	NY	AETNA HMO ID #
6	4C8738	OTHER	NY	HEALTHNET ID #
7	P3608471	OTHER	NY	OXFORD 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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