Provider Demographics
NPI:1215107693
Name:BRESLOW, STEVEN J (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:BRESLOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:390 VINEYARD WAY BLDG 500
Mailing Address - Street 2:#501
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-8835
Mailing Address - Country:US
Mailing Address - Phone:610-869-0953
Mailing Address - Fax:610-569-5824
Practice Address - Street 1:390 VINEYARD WAY BLDG 500
Practice Address - Street 2:#501
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-8835
Practice Address - Country:US
Practice Address - Phone:610-869-0953
Practice Address - Fax:610-569-5824
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS13929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020972430003Medicaid
PA128146ZCXXMedicare PIN