Provider Demographics
NPI:1083675037
Name:BREUER, PAUL M (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:BREUER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 FT WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4626
Mailing Address - Country:US
Mailing Address - Phone:212-928-1171
Mailing Address - Fax:212-543-0666
Practice Address - Street 1:495 FT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4626
Practice Address - Country:US
Practice Address - Phone:212-928-1171
Practice Address - Fax:212-543-0666
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0029971152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00330483Medicaid
C95091Medicare ID - Type Unspecified
NY00330483Medicaid