Provider Demographics
NPI:1538255567
Name:BREITBART, ARNOLD S (MD)
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:S
Last Name:BREITBART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 NORTHERN BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3040
Mailing Address - Country:US
Mailing Address - Phone:516-365-3511
Mailing Address - Fax:516-365-3611
Practice Address - Street 1:1155 NORTHERN BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3040
Practice Address - Country:US
Practice Address - Phone:516-365-3511
Practice Address - Fax:516-365-3611
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY167302208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2138715OtherVYTRA
NYN94677OtherHEALTH NET
NYP3618728OtherOXFORD
NYN94677OtherHEALTH NET
NY07L931Medicare PIN
NYF77629Medicare UPIN