Provider Demographics
NPI:1285600973
Name:BREIDBART, RORY STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:RORY
Middle Name:STEVEN
Last Name:BREIDBART
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1999 MARCUS AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1021
Mailing Address - Country:US
Mailing Address - Phone:516-467-8600
Mailing Address - Fax:929-455-9855
Practice Address - Street 1:1999 MARCUS AVE STE 212
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1021
Practice Address - Country:US
Practice Address - Phone:516-467-8600
Practice Address - Fax:929-455-9855
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74940207RE0101X
NY175465207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
F44462Medicare UPIN
NY20L591Medicare ID - Type Unspecified