Provider Demographics
NPI:1528407939
Name:BRESKI, MICHAELA MARIE
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:MARIE
Last Name:BRESKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 N WOODSTOCK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1438
Mailing Address - Country:US
Mailing Address - Phone:717-592-1748
Mailing Address - Fax:
Practice Address - Street 1:531 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4416
Practice Address - Country:US
Practice Address - Phone:610-692-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant